A study of acute kidney injury in hospitalized preterm neonates in NICU

Nagaraj, Niranjan; Berwal, Pramod Kumar; Srinivas, Anusha; Berwal, Ayush

doi:10.3233/npm-161614

Cited by 26 publications

(14 citation statements)

References 6 publications

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“…Fetal insults, including CA that is often accompanied with preterm birth, elicit inflammation in multiple organs and may further worsen the renal outcomes. Early management of kidney inflammation may ameliorate growth failure and suboptimal neurodevelopmental outcomes for preterm infants (55,56), but reliable diagnostic markers for neonatal kidney diseases are lacking, and underlying mechanisms of the diseases are poorly understood. In the current study with preterm pigs, we demonstrated for the first time that CA, induced by IA LPS exposure, resulted in renal inflammation both at birth and 5 days after preterm birth with the involvement of innate and adaptive immune activation.…”

Section: Discussionmentioning

confidence: 99%

Prenatal Endotoxin Exposure Induces Fetal and Neonatal Renal Inflammation via Innate and Th1 Immune Activation in Preterm Pigs

et al. 2020

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Chorioamnionitis (CA) predisposes to preterm birth and affects the fetal mucosal surfaces (i.e., gut, lungs, and skin) via intra-amniotic (IA) inflammation, thereby accentuating the proinflammatory status in newborn preterm infants. It is not known if CA may affect more distant organs, such as the kidneys, before and after preterm birth. Using preterm pigs as a model for preterm infants, we investigated the impact of CA on fetal and neonatal renal status and underlying mechanisms. Fetal pigs received an IA dose of lipopolysaccharide (LPS), were delivered preterm by cesarean section 3 days later (90% gestation), and compared with controls (CON) at birth and at postnatal day 5. Plasma proteome and inflammatory targets in kidney tissues were evaluated. IA LPSexposed pigs showed inflammation of fetal membranes, higher fetal plasma creatinine, and neonatal urinary microalbumin levels, indicating renal dysfunction. At birth, plasma proteomics revealed LPS effects on proteins associated with renal inflammation (upregulated LRG1, down-regulated ICA, and ACE). Kidney tissues of LPS pigs at birth also showed increased levels of kidney injury markers (LRG1, KIM1, NGLA, HIF1A, and CASP3), elevated molecular traits related to innate immune activation (infiltrated MPO + cells, complement molecules, oxidative stress, TLR2, TLR4, S100A9, LTF, and LYZ), and Th1 responses (CD3 + cells, ratios of IFNG/IL4, and TBET/GATA3). Unlike in plasma, innate and adaptive immune responses in kidney tissues of LPS pigs persisted to postnatal day 5. We conclude that prenatal endotoxin exposure induces fetal and postnatal renal inflammation in preterm pigs with both innate and adaptive immune activation, partly explaining the potential increased risks of kidney injury in preterm infants born with CA.

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Section: Discussionmentioning

confidence: 99%

Prenatal Endotoxin Exposure Induces Fetal and Neonatal Renal Inflammation via Innate and Th1 Immune Activation in Preterm Pigs

et al. 2020

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“…Due to prematurity, the immature kidney is more exposed to the effects of hypoperfusion and high rates of vascular resistance. Thus, renal flow is considerably reduced in preterm infants, which increases the chance of this population presenting AKI as a result of renal ischemia (18) . It should be emphasized that renal immaturity, from the anatomical and physiological point of view, makes extrauterine life difficult, sometimes hampered by malnutrition, drug nephrotoxicity and other complications present during hospitalization (19) .…”

Section: Discussionmentioning

confidence: 99%

Associated factors for acute kidney injury in preterm infants

et al. 2019

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Objective: to analyze the prevalence and factors associated with acute kidney injury in preterm newborns. Method: a cross-sectional study based on records data of preterm newborns hospitalized in two neonatal units in northwest Paraná State in 2015. For data analysis, the logistic regression model was used by the stepwise forward method and Fisher's Exact Test. Results: 132 preterm newborns, with a prevalence of 7.5% of acute kidney injury, were hospitalized. Majority of males, extremely preterm and very low birth weight. Associated factors were the use of non-nephrotoxic antibiotics and the presence of mechanical pulmonary ventilation, increasing the chance of developing acute kidney damage by 2.98 and 1.33/day, respectively. Hospitalization days constituted a protection factor. Conclusion: this study was able to identify the prevalence, and outline the variables associated with acute kidney injury in preterm newborns in a particular care situation. RESUMOObjetivo: analisar a prevalência e fatores associados à lesão renal aguda em recém-nascidos prematuros. Método: estudo transversal realizado a partir de dados de prontuários de recémnascidos prematuros internados em duas unidades neonatais do noroeste paranaense em 2015. Para análise dos dados, utilizou-se o modelo de regressão logística pelo método stepwise forward e Teste Exato de Fisher. Resultados: foram internados 132 prematuros, com prevalência de 7,5% de lesão renal aguda. Maioria do sexo masculino, prematuros extremos e com muito baixo peso ao nascer. Os fatores associados foram o uso de antibióticos não nefrotóxicos e a presença de ventilação pulmonar mecânica, aumentando em 2,98 e 1,33/dia a chance do desenvolvimento de lesão renal aguda, respectivamente. Os dias de hospitalização constituíram fator de proteção. Conclusão: este estudo foi capaz de identificar a prevalência e delinear as variáveis associadas à ocorrência de lesão renal aguda em recém-nascidos prematuros numa determinada realidade assistencial. RESUMENObjetivo: analizar la prevalencia y factores asociados a la lesión renal aguda en recién nacidos prematuros. Método: estudio transversal realizado a partir de datos de prontuarios de recién nacidos prematuros internados en 2 unidades neonatales del noroeste del estado de Paraná en 2015. Para el análisis de los datos, se utilizó el modelo de regresión logística por el método stepwise forward y Test Exacto de Fisher. Resultados: fueron internados 132 prematuros, con prevalencia del 7,5% de lesión renal aguda. La mayoría era del sexo masculino, prematuros extremos y con muy bajo peso al nacer. Los factores asociados fueron el uso de antibióticos no nefrotóxicos y la presencia de ventilación pulmonar mecánica, aumentando en 2,98 y 1,33/día la posibilidad del desarrollo de lesión renal aguda, respectivamente. Los días de hospitalización constituyeron un factor de protección. Conclusión: este estudio fue capaz de identificar la prevalencia y delinear las variables asociadas a la ocurrencia de lesión renal aguda en recién nacidos prematuros en un...

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“…Renal flow is considerably reduced in preterm infants, which increases the chance of this population presenting AKI as a result of renal ischemia [15] [16] [17]. It should be emphasized that renal immaturity, from the anatomical and physiological point of view, makes extra uterine life difficult, sometimes hampered by malnutrition, drug nephrotoxicity and other complications present during hospitalization [10].…”

Section: Resultsmentioning

confidence: 99%

Does Caffeine Citrate Administration Decrease Risk of Acute Kidney Injury in Hospitalized Preterm Neonates?

Mohamed¹,

Fahmy²,

Mohamed³

2021

OJPed

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Background: Acute kidney injury (AKI) is a life threatening condition with still high mortality rate in neonates. Early recognition of the risk factors and the rapid effective treatment of the contributing conditions will reduce AKI in the neonatal period. Aim of the Work: To determine association between early caffeine citrate administration and risk of acute kidney injury in hospitalized preterm neonates. Patients and Methods: This study was a prospective study that was conducted at the NICU of El Galaa Teaching Hospital. This study included 100 preterm neonates who were born alive from 32 weeks to 35 weeks of gestation. Results: There was highly statistically significant occurrence of apneaic episode in preterm babies who don't receive caffeine citrate and consequently decreased incidence of AKI in those babies. Conclusion: We concluded that caffeine citrate administration in preterm babies is associated with reduced incidence of apneaic episode and consequently reduced risk of AKI.

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A study of acute kidney injury in hospitalized preterm neonates in NICU

Abstract: AKI is not uncommon in preterm infants. The early recognition and aggressive management of episodes of shock which often precede AKI could be life-saving.

Cited by 26 publications

References 6 publications

Prenatal Endotoxin Exposure Induces Fetal and Neonatal Renal Inflammation via Innate and Th1 Immune Activation in Preterm Pigs

Prenatal Endotoxin Exposure Induces Fetal and Neonatal Renal Inflammation via Innate and Th1 Immune Activation in Preterm Pigs

Associated factors for acute kidney injury in preterm infants

Does Caffeine Citrate Administration Decrease Risk of Acute Kidney Injury in Hospitalized Preterm Neonates?

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