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Perinatal factors associated with acute kidney injury in preterm infants - a matched case control study

Presented at the Neonatal Society 2010 Summer Meeting (programme).

Bhojani S, Bhojani S, Banerjee J, Holmqvist L (introduced by Anupam Shrivastava)

Southend University Hospital, Prittlewell chase, Southend on Sea, Essex SS0 0RY, UK

Aim: Acute kidney injury (AKI) is an established contributing factor of morbidity and mortality in preterm infants (1) but the influence of perinatal factors on AKI is unclear. This study aimed to evaluate the perinatal risk factors in infants born before 32 weeks gestation with AKI.

Methods: Data was collected retrospectively from a Level two Neonatal Unit at a District General Hospital in UK identifying all preterm infants born between January 2007 and January 2010. Infants with AKI were identified using the Acute Kidney Injury Network criteria (2) (Increase in serum creatinine ≥26.2 µmol/L or increase to 150-199% from baseline). Each case was matched by birth weight (BW) (±100 gms) and gestational age (GA) (±1 week) with up to 2 controls. Data on perinatal factors and serum creatinine was collected from patient case notes, for the first week of life. Local Ethical Committee approval was not required for this retrospective study.

Results: 55 cases were identified and matched to 65 controls.

(Statistical analysis - Cord pH, Apgar ± Standard Error of mean, others Standard Deviation, column %)

Antenatal Steroids were found to make significant difference with Odds Ratio of 0.23 (95% 0.07-0.78, p 0.01). Infants needing ventilatory support were more likely to have AKI (p 0.001).

Conclusion: Antenatal steroids are likely to have a protective effect against AKI in preterm infants. Large prospective randomised studies are needed to confirm the relation between antenatal steroids and AKI.

1. David J. Askenazi, Russell Griffin, Gerald McGwin, Waldemar Carlo, Namasivayam Ambalavanan; Acute kidney injury is independently associated with mortality in very low birthweight infants: a matched case–control analysis; Pediatr Nephrol (2009) 24:991–997
2. Sean M. Bagshaw, Carol George and Rinaldo Bellomo; A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients; Nephrol Dial Transplant (2008) 23: 1569–1574

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