Potential risk factors for the development of acute renal failure in preterm newborn infants: a case-control study

Abstract

Aims: To determine in a case-control study possible associations between the development of acute renal failure in preterm newborns and therapeutic interventions, particularly drug treatments. Methods: The study population was 172 preterm infants of ,38 weeks gestation; 71 had acute renal failure and 101 were controls closely matched for gestational age and birth weight. Maternal and neonatal information was collected for both groups through questionnaires and interviews. Routine data on renal variables were also collected. Univariate and multivariate logistic regression analyses were performed. Results: Very low birthweight infants were at high risk of acute renal failure (79% of cases were ,1500 g). However, the acute renal failure was transient. Mothers of infants with acute renal failure received more drugs during pregnancy and delivery (mainly antibiotics and non-steroidal anti-inflammatory drugs). Of the possible therapeutic interventions, intubation, catheterisation, and phototherapy were mainly applied to case subjects. A low Apgar score and patent ductus arteriosus were diagnosed in a greater percentage of neonates with acute renal failure. Moreover, in the first few days of life and before diagnosis of acute renal failure, case subjects received more drugs (antibiotics, non-steroidal anti-inflammatory drugs, and diuretics) and for a longer time. In the multivariate logistic analysis, medullary hyperechogenicity (odds ratio (OR) 4.491; 95% confidence interval (CI) 1.879 to 10.731) and ceftazidime administration (OR 5.082; 95% CI 1.493 to 17.297) were associated with a greater risk of acute renal failure. Conclusions: The results suggest the need for careful monitoring of very low birthweight infants and attention to drug treatments, as it is difficult to differentiate between normality and renal failure in the first few days of life.

Elevation in plasma creatinine and renal failure in premature neonates without major anomalies: terminology, occurrence and factors associated with increased risk

“…Prolonged exposure to antibiotics and the use of indomethacin were independent factors associated with an increased risk of renal dysfunction/failure. The risk factors we identified that are associated with renal dysfunction are similar to those previously reported, 1,3,5 and some of these risk factors are potentially modifiable. Cataldi et al 5 showed that low birth weight, maternal exposure to more drugs during pregnancy and delivery (mainly antibiotics and nonsteroidal anti-inflammatory drugs), low Apgar scores and patent ductus arteriosus were the risk factors for renal failure in low-birth-weight infants.…”

“…[1][2][3][4][5][6][7][8] This complexity is highlighted by how the terms 'renal dysfunction' and 'renal failure' are used in our data set. Only 15% of infants with any creatinine X1.3 mg per 100 ml and 33% of infants with any creatinine X2.0 mg per 100 ml were identified as having 'renal problems.'…”

“…[1][2][3][4][5] Unfortunately, there is no consensus on diagnostic criteria of acute renal failure in newborn infants. Some authors have suggested a persistent increase in plasma creatinine concentration >1.5 mg per 100 ml 6,7 but more stringent criteria were proposed by others.…”

“…The measurement and interpretation of renal function in premature neonates is complicated by in utero events, maternal drug exposure history, delivery history, gestational age, birth weight, postnatal illness severity, renal development and changing muscle mass. 1,3,5,9,10 Plasma creatinine and blood urea nitrogen measurements are commonly used to assess renal function and protein tolerance in premature neonates. However, data on how these values change over time and how they are influenced by gestational age and birth weight are limited.…”

Urinary kidney injury molecule-1 rapid test predicts acute kidney injury in extremely low-birth-weight neonates

“…In neonates with AKI, mortality rate ranges from 33% up to 78% (1)(2)(3)(4). AKI is an independent predictor of mortality in critically ill newborns.…”