“Incidence of Acute Kidney Injury in Neonates with Perinatal Asphyxia”

Introduction: Perinatal asphyxia is an essential reason for neonatal mortality and neurological morbidity. Birth asphyxia occurs when a baby does not receive enough oxygen before, during or after birth. Perinatal asphyxia remains a common problem in the neonatal nursery and is a significant cause of morbidity and death in the term and preterm neonate. Aim of the study: The aim of this study was to determine the incidence of acute kidney injury (AKI) in neonates with perinatal asphyxia. Methods: This was a cross sectional observational study was conducted in NICU of Dr. MR Khan Shishu Hospital & Institute of Child Health, Dhaka, Bangladesh during the period from January 2018 to June 18. In total 125 neonates with perinatal asphyxia was selected as the study population. The cases were categorized according to Sarnat and Sarnat staging of HIE without EEG. Acute kidney injury (AKI) was considered in neonates who had a serum creatinine concentration >125 μmol/l or a serum creatinine concentration>100 μmol/l and oliguria (urine output <1ml/Kg/hour) for 24 hours or more on third day of neonatal age. All data during hospital stay including cases with AKI were taken and snalyzed using SPSS version 20. Result: In our study we found among 30 HIE-I stage patients only 1 had AKI which was 3.33%. Besides this, among 69 HIE stage II patients 13 had AKI which was 18.84% and among the rest 26 HIE-III patients 12 had AKI which was 46.15%. This ratio of HIE-III stage patients was the highest ratio of neonates with AKI. On the other hand in our study in analyzing the mean urine output and their biochemical values we found the mean Urine output (ml/kg/hr) was 1.21±0.17, the mean Blood urea (mg/dl) was 71.80±28.79, the mean Serum creatinine (mg/dl) was 2.01±0.11, the mean was Serum sodium (meq/L) , the mean Serum potassium (meq/L) was 4.97±0.51, the mean Serum chloride (meq/L) was 101.21±5.01, and the mean Creatinine clearance was 16.08±5.23. Conclusion: Birth asphyxia is an important cause of neonatal AKI in developing country especially like in Bangladesh. Majority of the neonates had non-oliguric AKI and responded well to fluid challenge. Abnormalities in the renal function correlates well with the severity of HIE staging. Intrinsic AKI, oliguria, hyponatremia, reduced creatinine clearance and abnormal sonographic scan suggest bad prognosis in neonatal AKI secondary to perinatal asphyxia.