To determinate the degree or severity of renal impairment according to HIE stages in PNA patients

Abstract

Introduction: Perinatal asphyxia is a major cause of acute renal failure in neonates. So it is essential to evaluate renal function at an early stage to stabilize fluid and electrolyte balance which is of great importance to infants with hypoxic-ischemic encephalopathy. Yet, it is not quite easy to evaluate neonatal renal function accurately. Objective: To Determinate the Degree or Severity of Renal Impairment According to HIE Stages in PNA Patients. Materials and Methods: This cross sectional study was carried out in the department of neonatology, Chattagram Ma-O-Shishu hospital from January 2016 to June 2016. All Perinatal asphyxia patients admitted in the department of neonatology, Chattagram Maa-Shishu O General Hospital fulfilling the inclusion criteria were included in the study. As the study was done in a single center and due to time constrain 180 cases were enrolled in this study. After taking informed written consent from legal attended a total of 150 asphyxiated and 30 non-asphyxiated newborns were selected by purposive sampling. Results: During the study period, there were total 197 eligible infants. Among them 154 were case and 43 were control. Among the cases 2 infants left against medical advice (LAMA), 1 infant died, and 1 was excluded due to lack of parental consent. Among the control 13 were excluded due to lack of consent. Finally, 150 asphyxiated newborns were selected as case and 30 normal infants were included as control in the study. In this study, stage I, 50(60.2%) baby has normal RFI and 33 (39.8%) babies have abnormally high RFI. For stage II, 23 (43.4%) baby has normal RFI and 30 (56.6%) baby has abnormally high RFI and for stage III, only 5 (35.7%) baby has normal RFI and 9 (64.3%) baby has abnormally high RFI. There P value is 0.070, which is statistically not significant. The study also shows Mean ± SD of RFI value in stage I is 2.76 ± 0.62, for Stage II is 3.17 ± 0.67 and for stage III, is 3.17 ± 0.28 and “p” value 0.001 which is statistically highly significant. Conclusion: In conclusion, AKI represent a significant problem among asphyxiated neonates. All of the hyperechogenic kidney patients were also hyperuricemic, which supports the possible association between both features. In addition, uric acid itself might be the causative factor for failure in addition to hypoxic and ischemic insult. We recommend kidney functions, and abdominal ultrasonography to be done routinely in asphyxiated neonates to evaluate the possibility of acute kidney injury in them. FENa and RFI are useful parameters for assessing the renal function and urinary β2M is a good biomarker for diagnosis and prognosis of acute tubular injury in term babies with perinatal asphyxia.