Glomerular Filtration Rate in Former Extreme Low Birth Weight Infants over the Full Pediatric Age Range: A Pooled Analysis

Abstract

Various cohort studies document a lower glomerular filtration rate (GFR) in former extremely low birth weight (ELBW, <1000 g) neonates throughout childhood when compared to term controls. The current aim is to pool these studies to describe the GFR pattern over the pediatric age range. To do so, we conducted a systematic review on studies reporting on GFR measurements in former ELBW cases while GFR data of healthy age-matched controls included in these studies were co-collected. Based on 248 hits, 6 case-control and 3 cohort studies were identified, with 444 GFR measurements in 380 former ELBW cases (median age 5.3–20.7 years). The majority were small (17–78 cases) single center studies, with heterogeneity in GFR measurement (inulin, cystatin C or creatinine estimated GFR formulae) tools. Despite this, the median GFR (mL/min/1.73 m2) within case-control studies was consistently lower (−13%, range −8% to −25%) in cases, so that a relevant minority (15–30%) has a eGFR<90 mL/min/1.73 m2). Consequently, this pooled analysis describes a consistent pattern of reduced eGFR in former ELBW cases throughout childhood. Research should focus on perinatal risk factors for impaired GFR and long-term outcome, but is hampered by single center cohorts, study size and heterogeneity of GFR assessment tools.

Renal Precision Medicine in Neonates and Acute Kidney Injury: How to Convert a Cloud of Creatinine Observations to Support Clinical Decisions

“…It is hereby important to highlight that follow-up of these populations remains important after hospital discharge as there are concerns on the long-term renal outcome, most pronounced in former ELBW cases ( 63 ). Research should focus on perinatal risk factors associated with impaired GFR in long-term outcome studies, but is hampered by single center cohorts, small samples sizes, and heterogeneity of GFR assessment tools ( 64 ). The diagnosis of AKI remains complex with integrated assessment both of diuresis and S cr or Cystatin C to tailor clinical care and pharmacotherapy.…”

Effects of size at birth on health, growth and developmental outcomes in children up to age 18: an umbrella review

“…Unlike most previous umbrella reviews, we mapped the specific associations between different small size-at-birth risk factors and specific detailed outcomes. We also identified 15 subthemes which were consistently associated with small size at birth that had not been included in previous umbrella reviews of associations with hospitalisation,52 asphyxia,54 retinopathy,55 epilepsy,64 other lung related measurements,51 82 83 kidney related diseases,85 87 105–107 attention,138 139 146–148 autism spectrum disorder,140 152 153 body composition,85 155–158 working memory,138 141 146 182 communication,138 148 174 183 190–192 educational outcomes language learning disorder,138 141 184 190 191 193 194 mathematics learning disorder,138 141 173 184 193 non-right handedness195 and combined neurological measurements 176. We found two subthemes (hypercholesterolaemia84 and lymphoma128) which consistently showed no association.…”

“…Figure 3 summarises findings on the direction of the association by subtheme of online supplemental material 3 tables 1 a-g 46–195. Except for a few subthemes like undernutrition, most studies were conducted in high-income countries (online supplemental material 5).…”

Reductions in estimated glomerular filtration rate during puberty in GH-treated children born small for gestational age are associated with prematurity and low birth weight, not the dosage of GH treatment

“…Evidence suggests that LBW is directly associated with reduced nephron number, which is pathogenically related to the development of hypertension, renal dysfunction, and proteinuria ( 4 ). In addition, prematurity is also an important risk factor for reduced nephron number, as nephrons develop until 36 weeks of gestation ( 4 ); therefore, the median GFR is reportedly lower than that of controls during childhood in such patients, particularly in those born with extreme prematurity ( 25 ). Regular monitoring of renal function is warranted in short-statured children born SGA, especially when associated with prematurity and/or LBW irrespective of GH treatment.…”