Renal injury in the asphyxiated newborn infant: Relationship to neurologic outcome

doi:10.1016/S0022-3476(88)80023-4

The Journal of Pediatrics

Volume 113, Issue 5, November 1988, Pages 875-879

https://doi.org/10.1016/S0022-3476(88)80023-4 Get rights and content

The relationship of renal and central nervous system injury was prospectively evaluated in 120 asphyxiated infants. Renal evaluation findings were considered abnormal if there was oliguria (urine output <1 ml/kg/hr), which was designated transient if present in the first 24 hours only and persistent if present for at least 36 hours, or if the urinary β₂-microglobulin concentration from first-void urine was elevated: (1) Thirteen infants had persistent oliguria; the urinary β₂-microglobulin level was elevated in all. The six term infants had clinical signs consistent with hypoxic-ischemic encephalopathy (HIE); all six had ultrasonographic abnormalities. The outcome was poor (i.e., death or long-term neurologic deficits) in five of six infants. The seven preterm infants with persistent ollguira had clinical evidence of HIE, and three infants had intraventricular hemorrhage; all seven infants died. (2) Fifteen infants had transient oliguria (β₂-microglobulin level was elevated in eight infants). Two of the eight term infants had evidence for HIE; the cranial ultrasound scan was normal in all. At follow-up, seven term infants are normal and one is abnormal. Six of the seven preterm infants with transient oliguria had clinical evidence of HIE; three infants had intraventricular hemorrhage. Three infants died, and the four survivors are normal at follow-up. (3) Ninety-two infants had normal urine output. Of the 22 term infants, two developed signs of HIE, and the ultrasound scan was abnormal in three infants. Of the 70 preterm infants, eight (11%) had clinical signs consistent with HIE, the ultrasound scan was abnormal in 20 of 64 (31%) infants scanned, and 14 (20%) infants died. Most of the followed infants are normal. Thus oliguria was significantly associated with clinical signs of HIE, including seizures, death (specifically in the premature infant), and long-term neurologic deficits. These data suggest that oliguria in the perinatal period is a sensitive indicator of infants at risk for long-term neurologic deficits.

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Management of Hypoxic-Ischemic Encephalopathy Using Measures Other Than Therapeutic Hypothermia
2023, Principles of Neonatology
Neonatal encephalopathy (NE) is an alteration in consciousness or neurologic exam in the neonate. The possible etiologies of NE are broad, but it is most commonly caused by hypoxic-ischemic encephalopathy (HIE). The initial diagnosis of HIE relies on evidence of an acute or subacute (prolonged) perinatal event leading to brain injury and exam findings consistent with encephalopathy. Initial evaluation of an infant with suspected HIE should include perinatal history, biochemical assessment, and neurologic exam. Electroencephalogram (EEG) and imaging, when available, may confirm the diagnosis and severity. Although HIE occurs at all gestational ages, the assessment of encephalopathy in preterm infants is difficult and the clinical presentation of seizures may be subtle. Thus the search for a reliable, testable biomarker for outcome in HIE is the topic of ongoing research. Therapeutic hypothermia is the only available treatment for HIE in full-term infants thus far, which will be discussed in a separate chapter. Other neuroprotective strategies and future adjuvant therapies are discussed here.
Renal Saturation and Acute Kidney Injury in Neonates with Hypoxic Ischemic Encephalopathy Undergoing Therapeutic Hypothermia
2018, Journal of Pediatrics
Citation Excerpt :
Additional research may also include utilization of urine biomarker data to quantify kidney injury in addition to measures by serum creatinine or urine output alone. AKI has been identified as an independent predictor of morbidity and mortality in neonates,28,29,35-38 and early identification of AKI may enhance prognosis with respect to neurodevelopmental outcome.12,39,40 Evaluation of additional therapies to prevent or ameliorate AKI and their subsequent effects on renal oxygenation are needed.
To investigate the range of renal near-infrared spectroscopy (NIRS) measures in neonates undergoing therapeutic hypothermia for hypoxic ischemic encephalopathy (HIE) and to determine the association between renal NIRS measures and the development of acute kidney injury (AKI).
A retrospective chart review was conducted of neonates with moderate to severe HIE who received therapeutic hypothermia at a tertiary care center from 2014 to 2016. Neonates had routine continuous NIRS monitoring of cerebral and renal saturation (Rsat) as part of their clinical care for 72 hours of cooling and until 24 hours after rewarming. The outcome of AKI was defined by an abnormal rate of decline of serum creatinine over the first 5 days of life. Mixed effects models determined the association between renal NIRS measures and AKI over time.
Of 38 neonates with HIE undergoing cooling, 15 (39%) developed AKI. Rsat was lower than cerebral saturation during cooling (P < .01), but Rsat increased over time after rewarming, while renal oxygen extraction levels decreased (P < .0001). Neonates with AKI had higher Rsat levels (P < .01) compared with those without AKI after 24 hours of life. Using receiver operating characteristic curves, Rsat >75% by 24-48 hours predicted AKI with a sensitivity of 79% and specificity of 82% (area under the receiver operating characteristic curve = 0.76).
Throughout cooling, neonates with AKI had higher Rsat measures than those without AKI. These differences may reflect lower oxygen extraction by the injured kidney. NIRS monitoring of Rsat may identify neonates with HIE at risk of developing AKI.
Hypoxic-Ischemic Injury in the Term Infant
2018, Volpe's Neurology of the Newborn
Neonatal encephalopathy occurs in 2 to 5/1000 live births and is principally related to hypoxic-ischemic injury to the newborn brain in the immediate peripartum period. In the last decade, there have been significant advances in neuroprotection that have been successful in reducing the risk of death and disability in infants who have suffered from a potential hypoxic-ischemic cerebral injury. The advent of therapeutic hypothermia has led to a major focus on the early clinical recognition of infants that may benefit from such therapies. In addition, optimal recognition and therapeutic targeting of neonatal seizures, with other neuroprotective approaches, have been emphasized. This chapter will summarize the clinical presentation, neuropathological correlates, neurodiagnostic evaluation, prognosis, and management of this condition.
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2022, Pediatrics International
Positive fluid balance is associated with death and severity of brain injury in neonates with hypoxic–ischemic encephalopathy
2021, Journal of Perinatology

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^†: Supported in part by General Clinical Research Center grant No. NIH RR0036.

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Renal injury in the asphyxiated newborn infant: Relationship to neurologic outcome†

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

J Pediatr

Kidney Int

Neurology of the newborn

Antecedents of cerebral palsy: multivariate analysis of risk

N Engl J Med

Perinatal cardiac arrest: quality of the survivors

Arch Dis Child

Outcome of very severe birth asphyxia

Arch Dis Child

Do Apgar scores indicate asphyxia?

Lancet

The Apgar score: is it enough?

Obstet Gynecol

Apgar scores and umbilical arterial pH in preterm newborn infants

Am J Obstet Gynecol