Plasma Creatinine Rises Dramatically in the First 48 Hours of Life in Preterm Infants

Miall, Lawrence; Henderson, Michael; Turner, Alison; Brownlee, K.; Brocklebank, J T; Newell, S J; Allgar, Victoria

doi:10.1542/peds.104.6.e76

Cited by 97 publications

(79 citation statements)

References 18 publications

(27 reference statements)

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“…After birth, SeCr increases in the first 48 h in preterm infants. 7,8 Consistent with these data, our results showed that the main factors analyzed found to be related to baseline SeCr were HDP, a condition that is often associated with high maternal levels of SeCr, and advancing hour of life. Placental abruption and GA explained only a very small proportion of the variability of the first day neonatal SeCr in our study.…”

Section: Discussionsupporting

confidence: 88%

“…Moreover, a positive correlation between SeCr at admission in NICU and GA was not observed in previous investigations. 5,6,8,17,21 Therefore, the finding of a positive correlation between GA and baseline SeCr, though statistically significant, should be interpreted with caution.…”

Section: Discussionmentioning

confidence: 96%

“…5 Both the increased peak and the slow decrease of SeCr in smaller premies reflect decreased renal function associated with low GA. 6 Postnatal SeCr changes in preterm infants may result from tubular creatinine reabsorption in the immature kidney 7 and from a physiologically low GFR during the first days of life. 8 Moreover, in sick preterm infants, many clinical conditions inducing hypotension, hypovolemia and hypoxemia and the use of nephrotoxic drugs may lead to further reduction of GFR. 9 In particular, nonsteroidal anti-inflammatory drugs (NSAID) that are given for treatment of patent ductus arteriosus (PDA) have been reported to impair renal perfusion 10 and the immature kidney is regarded as especially sensitive to NSAID renal effects.…”

Section: Introductionmentioning

confidence: 99%

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Factors affecting postnatal changes in serum creatinine in preterm infants with gestational age <32 weeks

et al. 2008

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

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Factors affecting postnatal changes in serum creatinine in preterm infants with gestational age <32 weeks

et al. 2008

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“…2 Others have also reported reduced GFR values during the first 48 h of life secondary to the inability of premature kidneys to clear high SCr values. 3,14 To determine the relationship between SCr and GA, and SCr and BW in VLBW infants, SCr values of all VLBW infants were studied during their first days of life. The fifth day of life was chosen to study the relationship between SCr and GA or BW because SCr reached a plateau between the fourth and sixth day of life.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4] While in the immediate postnatal period the newborn SCr likely reflect maternal values, 2,4 further increase in the levels of SCr in premature infants have been attributed to increased tubular reabsorption of creatinine due to renal tubular immaturity and also to reduced creatinine clearance. 2,3 It has also been shown by several investigators that creatinine clearance and glomerular filtration rate (GFR) increase with postnatal age in premature infants, [5][6][7][8] and in the absence of urine creatinine measurements, SCr can be used to estimate GFR. [9][10][11][12] However, little is known about the relationship between gestational age/birth weight (GA/BW) and SCr in VLBW infants at birth following stabilization of their SCr.…”

Section: Introductionmentioning

confidence: 99%

Serum creatinine in very low birth weight infants during their first days of life

Auron

Mhanna

2006

J Perinatol

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Objectives: Little is known about the relationship between gestational age (GA) or birth weight (BW) and serum creatinine (SCr) in very low birth weight (VLBW) infants. We sought to study postnatal SCr changes and determine if there is a correlation between GA or BW and SCr in VLBW infants, during their first days of life.Study Design: Medical records of all VLBW infants, who were admitted to our neonatal intensive care unit (NICU) between 1 May 1998 and 1 May 2001, were reviewed. Medical records were reviewed for: BW, GA, gender, race, APGAR scores, mechanical ventilation, use of medications, fluid intake, urinary output, protein intake, blood urea nitrogen (BUN) and SCr during the first days of life. Patients with anuria/oliguria, major congenital anomalies, low APGAR scores at 5 min, on high ventilator settings (on the oscillator), hemodynamically unstable (on pressors, inotropes) and on indomethacin and diuretics were excluded.Results: In total, 138 infants met our inclusion criteria. SCr was found to decrease postnatally, reaching a plateau on day 5 of life in all VLBW infants (repeated measure analysis of variance; P ¼ 0.004); however, there was a delay in the decrease of SCr in the subgroup of infants <29 weeks GA, and <1000 g BW. SCr (on day 5 of life) was also found to decrease with increasing GA and BW (Pearson correlation coefficient: À0.206 (P ¼ 0.05) and À0.236 (P ¼ 0.05) respectively). Conclusion:In VLBW infants SCr decreases significantly during the first days of life; however, in infants younger than 29 weeks GA or smaller than 1000 g BW there is a delay in the decrease of their SCr that extends beyond the first days of life. We also conclude that during the first days of life, and in VLBW infants SCr decreases with advancing GA and BW.

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Markers of Kidney Function in Early Childhood and Association With Maternal Comorbidity

et al. 2022

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ImportanceKidney functional capacity is low at birth but doubles during the first 2 weeks of life and reaches near-adult levels at age 1 to 2 years. Existing reference intervals for markers of kidney function in newborns are mostly based on preterm newborns, newborns with illness, or small cohorts of term newborns, and the consequences of maternal comorbidities for newborn kidney function are sparsely described.ObjectiveTo establish robust reference intervals for creatinine and urea in healthy children in early childhood and to assess whether maternal comorbidity is associated with newborn creatinine and urea concentrations.Design, Setting, and ParticipantsThis multicenter, prospective, population-based cohort study assessed data and umbilical cord blood samples from participants in the Copenhagen Baby Heart Study (CBHS) who were born between April 1, 2016, and October 31, 2018, and venous blood samples from a subsample of CBHS participants who were enrolled in the COMPARE study between May 3, 2017, and November 4, 2018. Cord blood samples of 13 354 newborns from the CBHS and corresponding venous blood samples of 444 of those newborns from the COMPARE study were included. Blood samples were collected at birth, age 2 months, and age 14 to 16 months, with follow-up completed on February 12, 2020. Healthy nonadmitted term newborns from maternity wards at 3 hospitals in the Capital Region of Denmark were included.ExposuresMaternal comorbidity.Main Outcomes and MeasuresCreatinine and urea concentrations.ResultsAmong 13 354 newborns in the CBHS cohort, characteristics of 12 938 children were stratified by sex and gestational age (GA). Of those, 6567 children (50.8%) were male; 5259 children (40.6%) were born at 37 to 39 weeks’ GA, and 7679 children (59.4%) were born at 40 to 42 weeks’ GA. Compared with children born at 40 to 42 weeks’ GA, those born at 37 to 39 weeks’ GA had lower birth weight, Apgar scores at 5 minutes, placental weight, and placental-fetal weight ratio. Children born at 37 to 39 weeks’ GA vs those born at 40 to 42 weeks’ GA were more frequently small for GA at birth and more likely to have placental insufficiency and exposure to maternal preeclampsia, maternal diabetes, maternal kidney disease, and maternal hypertension. Among children born at 37 to 39 weeks’ GA, reference intervals were 0.54 to 1.08 mg/dL for creatinine and 5.32 to 14.67 mg/dL for urea; among children born at 40 to 42 weeks’ GA, reference intervals were 0.57 to 1.19 mg/dL for creatinine and 5.60 to 14.85 mg/dL for urea. At birth, multifactorially adjusted odds ratios among children exposed to preeclampsia were 9.40 (95% CI, 1.68-52.54) for a venous creatinine concentration higher than the upper reference limit, 4.29 (95% CI, 1.32-13.93) for a venous creatinine concentration higher than the 90th percentile, and 3.10 (95% CI, 1.14-8.46) for a venous creatinine concentration higher than the 80th percentile.Conclusions and RelevanceIn this study, improved reference intervals for creatinine and urea concentrations were generated. Preeclampsia was associated with an increased risk of high newborn creatinine concentrations, suggesting that newborns of mothers with preeclampsia need closer observation of their kidney function.

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Plasma Creatinine Rises Dramatically in the First 48 Hours of Life in Preterm Infants

Cited by 97 publications

References 18 publications

Factors affecting postnatal changes in serum creatinine in preterm infants with gestational age <32 weeks

Factors affecting postnatal changes in serum creatinine in preterm infants with gestational age <32 weeks

Serum creatinine in very low birth weight infants during their first days of life

Markers of Kidney Function in Early Childhood and Association With Maternal Comorbidity

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