Creatinine Trends and Patterns in Neonates Undergoing Whole Body Hypothermia: A Systematic Review

Borloo, Noor; Smits, Anne; Thewissen, Liesbeth; Annaert, Pieter; Allegaert, Karel

doi:10.3390/children8060475

Cited by 6 publications

(7 citation statements)

References 60 publications

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“…Aunque otros biomarcadores como la cistatina C parecen ser mejores evaluadores del daño renal, aun no están suficientemente validados en neonatos y, la realidad es que, hoy en día, la creatinina sérica continúa siendo el método más utilizado en la práctica clínica [23][24][25] .…”

Section: Discussionunclassified

“…En nuestro estudio, debido a la influencia materna en los valores de creatinina en las primeras horas de vida 26,27 , decidimos no evaluar dichos resultados. No obstante, en la citada revisión 25 se pone de manifiesto que ya en las primeras horas de vida existen valores de creatinina significativamente más altos en neonatos con EHI respecto a neonatos sanos. Con el paso de los días, al igual que en nuestro estudio, se objetiva una tendencia decreciente de dichos valores, pero con cifras superiores a neonatos sanos.…”

Section: Discussionunclassified

“…Teniendo en cuenta que los nuevos criterios de IRA (KDIGO) se basan, además de en la disminución del ritmo de diuresis, en la elevación proporcional de creatinina respecto a la creatinina basal y que los recién nacidos presentan una disminución fisiológica de dichos valores durante los primeros días de vida, estos criterios pueden suponer un infradiagnóstico. Además, los pacientes con EHI tienen valores más elevados de creatinina al nacimiento respecto a recién nacidos sanos, por lo que necesitarían un incremento absoluto mayor de las cifras de creatinina para cumplir los criterios de IRA, pudiendo aumentar el infradiagnóstico 25 .…”

Section: Discussionunclassified

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Evaluación renal y multiorgánica en el paciente con encefalopatía hipóxico-isquémica

Muñoz-Cutillas¹,

Merino-Hernández²,

Arriaga-Redondo³

et al. 2023

PER

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Perinatología y reProducción Humana ARTÍCULO ORIGINAL ResumenIntroducción: La encefalopatía hipóxico-isquémica (EHI) moderada-grave secundaria a asfixia perinatal puede afectar a cualquier órgano, empeorando el pronóstico. Objetivo: Evaluar la afectación renal y multiorgánica de estos pacientes. Material y método: Se incluyó a recién nacidos > 35 semanas con EHI moderada-grave tratados con hipotermia activa entre 2010 y 2020. Se evaluó la creatinina en tres periodos: 48-72 horas de vida, entre el 3.o y 7.o día de vida y del 7.o al 28.o día de vida. Resultados: Se incluyeron 135 pacientes: 112 con EHI moderada y 23 con EHI grave. Al comparar ambos grupos, se obtuvieron diferencias significativas a las 48-72 horas y entre 3.o-7.o día de vida. No hubo diferencias al comparar el método de hipotermia. Los pacientes con EHI grave presentaron mayor afectación hemodinámica, respiratoria y hepática. Conclusiones: Neonatos con EHI grave presentan aumento de los niveles de creatinina sérica y mayor afectación multiorgánica respecto a aquellos con EHI moderada.

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Section: Discussionunclassified

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Evaluación renal y multiorgánica en el paciente con encefalopatía hipóxico-isquémica

Muñoz-Cutillas¹,

Merino-Hernández²,

Arriaga-Redondo³

et al. 2023

PER

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“…The first 10 days of PNA were analyzed to assess recovery of kidney function over time. This time window was based on a systematic review suggesting this period sufficiently covers the TH-specific SCr pattern [6]. To facilitate pooling, the covariates collected in the datasets were restricted to birth weight, GA, survival (neonatal death, day 1–28, yes/no), and SCr values (day 1–10).…”

Section: Methodsmentioning

confidence: 99%

Serum Creatinine Patterns in Neonates Treated with Therapeutic Hypothermia for Neonatal Encephalopathy

et al. 2022

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Introduction: There is large variability in kidney function and injury in neonates with neonatal encephalopathy (NE) treated with therapeutic hypothermia (TH). Acute kidney injury (AKI) definitions that apply categorical approaches may lose valuable information about kidney function in individual patients. Centile serum creatinine (SCr) over postnatal age (PNA) may provide more valuable information in TH neonates. Methods: Data from seven TH neonates and one non-TH-treated, non-NE control cohorts were pooled in a retrospective study. SCr centiles over PNA, and AKI incidence (definition: SCr ↑≥0.3 mg/dL within 48 h, or ↑ ≥1.5 fold vs. the lowest prior SCr within 7 days) and mortality were calculated. Repeated measurement linear models were applied to SCr trends, modeling SCr on PNA, birth weight or gestational age (GA), using heterogeneous autoregressive residual covariance structure and maximum likelihood methods. Findings were compared to patterns in the control cohort. Results: Among 1,136 TH neonates, representing 4,724 SCr observations, SCr (10th–25th–50th–75th–90th–95th) PNA centiles (day 1–10) were generated. In TH neonates, the AKI incidence was 132/1,136 (11.6%), mortality 193/1,136 (17%). AKI neonates had a higher mortality (37.2–14.3%, p < 0.001). Median SCr patterns over PNA were significantly higher in nonsurvivors (p < 0.01) or AKI neonates (p < 0.001). In TH-treated neonates, PNA and GA or birth weight explained SCr variability. Patterns over PNA were significantly higher in TH neonates to controls (801 neonates, 2,779 SCr). Conclusions: SCr patterns in TH-treated NE neonates are specific. Knowing PNA-related patterns enable clinicians to better assess kidney function and tailor pharmacotherapy, fluids, or kidney supportive therapies.

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“…A significant decrease in CL is observed in neonates during therapeutic hypothermia, be it that the extent differs between routes of elimination and compounds, but is most pronounced for renal elimination [157,158]. Based on a systematic review on SCr trends and patterns in neonates undergoing WBH, the impact on renal elimination is most relevant in the first days of life, so during WBH (used in the first 3 days of postnatal life) [159]. Consequently, this time window overlaps with the 'early onset sepsis (EOS)' interval, and can affect PK and dosing of the most commonly used antibiotics in the EOS setting, like aminoglycosides or beta lactams, as reflected in Table 8 [160].…”

Section: Whole Body Hypothermia In Neonatesmentioning

confidence: 99%

Pharmacokinetics of Antibiotics in Pediatric Intensive Care: Fostering Variability to Attain Precision Medicine

et al. 2021

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Children show important developmental and maturational changes, which may contribute greatly to pharmacokinetic (PK) variability observed in pediatric patients. These PK alterations are further enhanced by disease-related, non-maturational factors. Specific to the intensive care setting, such factors include critical illness, inflammatory status, augmented renal clearance (ARC), as well as therapeutic interventions (e.g., extracorporeal organ support systems or whole-body hypothermia [WBH]). This narrative review illustrates the relevance of both maturational and non-maturational changes in absorption, distribution, metabolism, and excretion (ADME) applied to antibiotics. It hereby provides a focused assessment of the available literature on the impact of critical illness—in general, and in specific subpopulations (ARC, extracorporeal organ support systems, WBH)—on PK and potential underexposure in children and neonates. Overall, literature discussing antibiotic PK alterations in pediatric intensive care is scarce. Most studies describe antibiotics commonly monitored in clinical practice such as vancomycin and aminoglycosides. Because of the large PK variability, therapeutic drug monitoring, further extended to other antibiotics, and integration of model-informed precision dosing in clinical practice are suggested to optimise antibiotic dose and exposure in each newborn, infant, or child during intensive care.

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Creatinine Trends and Patterns in Neonates Undergoing Whole Body Hypothermia: A Systematic Review

Cited by 6 publications

References 60 publications

Evaluación renal y multiorgánica en el paciente con encefalopatía hipóxico-isquémica

Evaluación renal y multiorgánica en el paciente con encefalopatía hipóxico-isquémica

Serum Creatinine Patterns in Neonates Treated with Therapeutic Hypothermia for Neonatal Encephalopathy

Pharmacokinetics of Antibiotics in Pediatric Intensive Care: Fostering Variability to Attain Precision Medicine

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