Predictive value of renal oxygenation in the first day of life in premature infants with hemodynamically significant patent ductus arteriosus in early diagnosis of acute kidney injury
Background. Hemodynamically significant patent ductus arteriosus (HSPDA) leads to the phenomenon of “stealing” the systemic circulation and renal hypoperfusion, which can contribute to the development of acute kidney injury (AKI) in premature infants. Near-infrared spectroscopy (NIRS) method of ren...
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| Format: | Article |
| Language: | English |
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Zaslavsky O.Yu.
2020-11-01
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| Series: | Zdorovʹe Rebenka |
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| Online Access: | http://childshealth.zaslavsky.com.ua/article/view/219234 |
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| author | T.P. Borysova O.U. Obolonskaya |
| author_facet | T.P. Borysova O.U. Obolonskaya |
| author_sort | T.P. Borysova |
| collection | DOAJ |
| description | Background. Hemodynamically significant patent ductus arteriosus (HSPDA) leads to the phenomenon of “stealing” the systemic circulation and renal hypoperfusion, which can contribute to the development of acute kidney injury (AKI) in premature infants. Near-infrared spectroscopy (NIRS) method of renal oxygenation measurement on the first day of life may be useful in identifying the risk group for AKI in these patients. The study aimed to assess the prognostic value of renal oxygenation in the first day of life in premature infants with HSPDA in the early diagnosis of AKI. Materials and methods. We examined 74 premature babies (gestational age 29–36 weeks) who were treated in the Department of Anesthesiology and Intensive Care of Newborns. The patients were divided into three groups depending on the presence of a patent ductus arteriosus (PDA) and its hemodynamic significance: group I — 40 children with HSPDA, group II — 17 children with PDA without hemodynamic disorders, group III — 17 children with a closed arterial duct (CAD). In each of the groups, subgroups were identified: with the presence or absence of AKI. Clinical examination and treatment of premature infants were carried out according to the generally accepted routine. Diagnosis and stratification of AKI severity were carried out according to the criteria of neonatal modification KDIGO, for which the concentration of serum creatinine and the level of urine output were studied. Doppler echocardiography was performed at 5–11 hours of life. Regional renal oxygenation (RrSO2) was monitored using spectroscopy in the near-infrared range. Results. AKI on the third day of life was diagnosed in 52.5 % of children with HSPDA, which is 2.2 times more often than in children with PDA without hemodynamic significance (p < 0.05) and 4.4 times more often than in individuals with CAD (p < 0.007). On the fifth day of life, AKI was detected in two more children with HSPDA, and the total number increased to 57.5 %. In the groups of children with PDA without hemodynamic disorders and CAD, on the third and fifth days of life, only I grade AKI was registered. Whereas, children with HSPDA had II–III grade AKI. Renal oxygenation on the first day of life was below 68 %, mainly in children with HSPDA + AKI. Extremely low levels of RrSO2 on the first day, associated with the development of AKI on the third day, in the group of HSPDA + AKI were registered in 49–52 %. In children with HSPDA who developed AKI by the third day of life, the RrSO2 index on the first day of life was 56.1 ± 4.5 % versus 63.9 ± 9.72 % in children without AKI (p < 0.01). An inverse correlation was established between the RrSO2 indicator on the first day of life and the blood creatinine concentration on the third day of life (ρ = –0.434, p < 0.02). Conclusions. Low renal oxygenation on near-infrared spectroscopy on the first day of life is associated with the development of acute kidney injury on the third day of life in premature infants with HSPDA. |
| first_indexed | 2024-04-11T16:21:34Z |
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| language | English |
| last_indexed | 2024-04-11T16:21:34Z |
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| spelling | doaj.art-d5962f57598c41dfb2b6bcf2fd1c3c8b2022-12-22T04:14:22ZengZaslavsky O.Yu.Zdorovʹe Rebenka2224-05512307-11682020-11-0115751852410.22141/2224-0551.15.7.2020.219234219234Predictive value of renal oxygenation in the first day of life in premature infants with hemodynamically significant patent ductus arteriosus in early diagnosis of acute kidney injuryT.P. Borysova0O.U. Obolonskaya1SI “Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine”, Dnipro, UkraineSI “Dnipropetrovsk Medical Academy of the Ministry of Health of Ukraine”, Dnipro, UkraineBackground. Hemodynamically significant patent ductus arteriosus (HSPDA) leads to the phenomenon of “stealing” the systemic circulation and renal hypoperfusion, which can contribute to the development of acute kidney injury (AKI) in premature infants. Near-infrared spectroscopy (NIRS) method of renal oxygenation measurement on the first day of life may be useful in identifying the risk group for AKI in these patients. The study aimed to assess the prognostic value of renal oxygenation in the first day of life in premature infants with HSPDA in the early diagnosis of AKI. Materials and methods. We examined 74 premature babies (gestational age 29–36 weeks) who were treated in the Department of Anesthesiology and Intensive Care of Newborns. The patients were divided into three groups depending on the presence of a patent ductus arteriosus (PDA) and its hemodynamic significance: group I — 40 children with HSPDA, group II — 17 children with PDA without hemodynamic disorders, group III — 17 children with a closed arterial duct (CAD). In each of the groups, subgroups were identified: with the presence or absence of AKI. Clinical examination and treatment of premature infants were carried out according to the generally accepted routine. Diagnosis and stratification of AKI severity were carried out according to the criteria of neonatal modification KDIGO, for which the concentration of serum creatinine and the level of urine output were studied. Doppler echocardiography was performed at 5–11 hours of life. Regional renal oxygenation (RrSO2) was monitored using spectroscopy in the near-infrared range. Results. AKI on the third day of life was diagnosed in 52.5 % of children with HSPDA, which is 2.2 times more often than in children with PDA without hemodynamic significance (p < 0.05) and 4.4 times more often than in individuals with CAD (p < 0.007). On the fifth day of life, AKI was detected in two more children with HSPDA, and the total number increased to 57.5 %. In the groups of children with PDA without hemodynamic disorders and CAD, on the third and fifth days of life, only I grade AKI was registered. Whereas, children with HSPDA had II–III grade AKI. Renal oxygenation on the first day of life was below 68 %, mainly in children with HSPDA + AKI. Extremely low levels of RrSO2 on the first day, associated with the development of AKI on the third day, in the group of HSPDA + AKI were registered in 49–52 %. In children with HSPDA who developed AKI by the third day of life, the RrSO2 index on the first day of life was 56.1 ± 4.5 % versus 63.9 ± 9.72 % in children without AKI (p < 0.01). An inverse correlation was established between the RrSO2 indicator on the first day of life and the blood creatinine concentration on the third day of life (ρ = –0.434, p < 0.02). Conclusions. Low renal oxygenation on near-infrared spectroscopy on the first day of life is associated with the development of acute kidney injury on the third day of life in premature infants with HSPDA.http://childshealth.zaslavsky.com.ua/article/view/219234premature infantshemodynamically significant patent ductus arteriosusacute kidney injuryrenal oxygenation |
| spellingShingle | T.P. Borysova O.U. Obolonskaya Predictive value of renal oxygenation in the first day of life in premature infants with hemodynamically significant patent ductus arteriosus in early diagnosis of acute kidney injury Zdorovʹe Rebenka premature infants hemodynamically significant patent ductus arteriosus acute kidney injury renal oxygenation |
| title | Predictive value of renal oxygenation in the first day of life in premature infants with hemodynamically significant patent ductus arteriosus in early diagnosis of acute kidney injury |
| title_full | Predictive value of renal oxygenation in the first day of life in premature infants with hemodynamically significant patent ductus arteriosus in early diagnosis of acute kidney injury |
| title_fullStr | Predictive value of renal oxygenation in the first day of life in premature infants with hemodynamically significant patent ductus arteriosus in early diagnosis of acute kidney injury |
| title_full_unstemmed | Predictive value of renal oxygenation in the first day of life in premature infants with hemodynamically significant patent ductus arteriosus in early diagnosis of acute kidney injury |
| title_short | Predictive value of renal oxygenation in the first day of life in premature infants with hemodynamically significant patent ductus arteriosus in early diagnosis of acute kidney injury |
| title_sort | predictive value of renal oxygenation in the first day of life in premature infants with hemodynamically significant patent ductus arteriosus in early diagnosis of acute kidney injury |
| topic | premature infants hemodynamically significant patent ductus arteriosus acute kidney injury renal oxygenation |
| url | http://childshealth.zaslavsky.com.ua/article/view/219234 |
| work_keys_str_mv | AT tpborysova predictivevalueofrenaloxygenationinthefirstdayoflifeinprematureinfantswithhemodynamicallysignificantpatentductusarteriosusinearlydiagnosisofacutekidneyinjury AT ouobolonskaya predictivevalueofrenaloxygenationinthefirstdayoflifeinprematureinfantswithhemodynamicallysignificantpatentductusarteriosusinearlydiagnosisofacutekidneyinjury |