Acute Kidney Injury in Neonatal Hypoxic-Ischemic Encephalopathy Patients Treated with Therapeutic Hypothermia: Incidence and Risk Factors.

IF 0.8 4区医学 Q4 CRITICAL CARE MEDICINE

Therapeutic hypothermia and temperature management Pub Date : 2024-03-01 Epub Date: 2023-06-21 DOI:10.1089/ther.2023.0009

Emre Dincer, Sevilay Topçuoğlu, Elif Betül Keskin Çetinkaya, Özge Yatır Alkan, Elif Özalkaya, Selim Sancak, Güner Karatekin

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Abstract

Studies in infants with hypoxic-ischemic encephalopathy (HIE) due to perinatal asphyxia have generally focused on neurological outcomes. Although acute kidney injury (AKI) rate decreased in advent of therapeutic hypothermia (TH), it is still a common and important entity. In this retrospective study, we aimed to investigate the risk factors for AKI in HIE patients treated with hypothermia. Infants treated with TH due to HIE were reviewed retrospectively and infants who developed AKI and not were compared. Ninety-six patients were enrolled in the study. AKI developed in 27 (28%) patients and 4 (14.8%) of them were stage III AKI. In the AKI group, gestational age of the patients was significantly higher (p = 0.035), the 1st minute Apgar score was significantly lower (p = 0.042), and convulsions (p = 0.002), amplitude-integrated electroencephalography disorders (p = 0.025), sepsis (p = 0.017), need for inotropic therapy (p = 0.001), need of invasive mechanical ventilation (p = 0.03), and systolic dysfunction in echocardiography (p = 0.022) were significantly higher. In logistic regression tests, Apgar score at the 1st minute was found to be independent risk factor for developing AKI. AKI has the potential to worsen the neurological damage and correlates with morbidities of perinatal asphyxia. It is important to determine the incidence and risk factors for developing AKI in this delicate group of patients to prevent further renal damage.

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接受治疗性低温疗法的新生儿缺氧缺血性脑病患者的急性肾损伤：发病率和风险因素。

对围产期窒息导致的缺氧缺血性脑病（HIE）婴儿的研究通常侧重于神经系统的预后。虽然随着治疗性低温（TH）的出现，急性肾损伤（AKI）的发生率有所下降，但它仍然是一种常见且重要的疾病。在这项回顾性研究中，我们旨在调查接受低体温治疗的 HIE 患者发生急性肾损伤的风险因素。我们对因 HIE 而接受低体温治疗的婴儿进行了回顾性研究，并对发生 AKI 的婴儿和未发生 AKI 的婴儿进行了比较。共有96名患者参与了研究。27例（28%）患者出现了AKI，其中4例（14.8%）为III期AKI。在 AKI 组中，患者的胎龄明显较高（P = 0.035），第 1 分钟 Apgar 评分明显较低（P = 0.042），抽搐（P = 0.002）、振幅积分脑电图紊乱（P = 0.025）、败血症（p = 0.017）、肌力治疗需求（p = 0.001）、有创机械通气需求（p = 0.03）和超声心动图收缩功能障碍（p = 0.022）明显更高。在逻辑回归测试中发现，第 1 分钟的 Apgar 评分是发生 AKI 的独立风险因素。AKI 有可能加重神经损伤，并与围产期窒息的发病率相关。在这一脆弱的患者群体中确定发生 AKI 的发生率和风险因素以防止进一步的肾损伤非常重要。

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来源期刊

Therapeutic hypothermia and temperature management CRITICAL CARE MEDICINE-

CiteScore

2.50

自引率

8.30%

发文量

期刊介绍： Therapeutic Hypothermia and Temperature Management is the first and only journal to cover all aspects of hypothermia and temperature considerations relevant to this exciting field, including its application in cardiac arrest, spinal cord and traumatic brain injury, stroke, burns, and much more. The Journal provides a strong multidisciplinary forum to ensure that research advances are well disseminated, and that therapeutic hypothermia is well understood and used effectively to enhance patient outcomes. Novel findings from translational preclinical investigations as well as clinical studies and trials are featured in original articles, state-of-the-art review articles, protocols and best practices. Therapeutic Hypothermia and Temperature Management coverage includes: Temperature mechanisms and cooling strategies Protocols, risk factors, and drug interventions Intraoperative considerations Post-resuscitation cooling ICU management.