A retrospective study on the incidence of acute kidney injury and its early prediction using troponin-I in cooled asphyxiated neonates

Abstract

Acute kidney injury (AKI) is a common complication of perinatal asphyxia and is associated with poorer short-term and long-term outcomes. This retrospective study describes the incidence of AKI in asphyxiated neonates who have received therapeutic hypothermia using the proposed modified Kidney Diseases: Improving Global Outcomes (KDIGO) definition and investigates clinical markers that would allow earlier recognition of at-risk neonates. We included asphyxiated neonates who underwent therapeutic hypothermia between the period of January 2011 and May 2018 in our study. The serum creatinine levels within a week of birth were used in establishing AKI according to the modified KDIGO definition. Demographic data, resuscitation details, laboratory results and use of medications were collected and compared between the AKI and non-AKI groups to identify variables that differed significantly. A total of 66 neonates were included and 23 out of them (35%) were found to have AKI. The neonates with AKI had a lower gestational age (p = 0.006), lower hemoglobin level (p = 0.012), higher lactate level before and after therapeutic hypothermia (p = 0.013 and 0.03 respectively) and higher troponin-I level after therapeutic hypothermia (p < 0.001). After logistic regression analysis, elevated troponin-I after therapeutic hypothermia was independently associated with risk of AKI (OR 1.69, 95% CI 1.067–2.699, p = 0.025). The receiver operating curve showed that troponin-I after therapeutic hypothermia had an area under curve of 0.858 at the level 0.288 ng/ml. Our study concludes that the incidence of AKI among asphyxiated newborns who received therapeutic hypothermia is 35% and an elevated troponin-I level after therapeutic hypothermia is independently associated with an increased risk of AKI in asphyxiated newborns.

Glomerular Filtration Rate in Asphyxiated Neonates Under Therapeutic Whole-Body Hypothermia, Quantified by Mannitol Clearance

“…In 36 asphyxiated neonates (mild, moderate, severe), acute kidney injury (AKI) was observed in 1/11 (9%) neonates with moderate sphyxia and in 12/25 (56%) neonates with severe asphyxia [4]. When we focus on cases that underwent TH (commonly restricted to moderate-to-severe HIE), AKI was observed in 35-42% [5][6][7]. Creatinine in the first days of life reflects to a certain extent maternal kidney function, assay-related differences still matter, while reference centile values following…”

Troponin I Levels in Neonatal Hypoxic–Ischemic Encephalopathy Are Related to Cardiopulmonary Comorbidity and Neurodevelopmental Outcomes

“…In patients treated with hypothermia therapy, neonatal hypotension could have caused secondary damage and further brain consequence. In a recent study, troponin-I levels, especially at levels >0.3 ng/mL, after therapeutic hypothermia was an independent factor for increased risk of acute kidney injury in asphyxiated newborns [29].…”

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

“…A strength of this literature review was the extensive search conducted in four databases, using a hand search to include the maximum number of relevant results, and an independent analysis by two authors. As an additional "external" reflection on the uncertainties in the pattern as described, we noticed that after our search strategy was finalized, the Mok et al data were plotted (Figure 4) [55]. This more recently published data set provided information on a more blunted decrease of Scr in the second part of the first week of postnatal life.…”

“…As the result of an additional "external" effort to find more recently published (after 01 May 2020) reports to further refine the Scr pattern described based on the cohorts retained in the meta-analysis, Mok et al (published September 2020) published another retrospective observational cohort that-post hoc-also meets all inclusion criteria of our literature review [55]. As an "external validation", we plotted these Scr observations (day 1-7) in Figure 4 on top of the data initially summarized in Figure 3.…”

“…Figure 4. Serum creatinine (Scr) data as reported in the individual retained studies (dashed, grey trends) compared to centile (10th, 25th, 50th, 75th, and 90th centiles) trend values (full grey) in the reference cohort (Table1) in the first week of postnatal life with the trends in Scr mean values as reported in the Mok cohort (66 cases, orange) added[27,[36][37][38][39][40][41][42][43][44][45][46][47][48]55].…”