Patent ductus arteriosus is associated with acute kidney injury in the preterm infant

2019 ◽  
Vol 34 (6) ◽  
pp. 1129-1139 ◽  
Author(s):  
Batoule Majed ◽  
David A. Bateman ◽  
Natalie Uy ◽  
Fangming Lin
Keyword(s):  
Acute Kidney Injury ◽  
Patent Ductus Arteriosus ◽  
Preterm Infant ◽  
Ductus Arteriosus ◽  
Kidney Injury ◽  
Patent Ductus

scholarly journals Urinary acute kidney injury biomarkers in very low-birth-weight infants on indomethacin for patent ductus arteriosus

2019 ◽  
Vol 85 (5) ◽  
pp. 678-686 ◽  
Author(s):  
Sina Waldherr ◽  
Alexander Fichtner ◽  
Bernd Beedgen ◽  
Thomas Bruckner ◽  
Franz Schaefer ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Patent Ductus Arteriosus ◽  
Very Low Birth Weight ◽  
Ductus Arteriosus ◽  
Kidney Injury ◽  
Low Birth Weight Infants ◽  
Patent Ductus

scholarly journals Echocardiographic predictors of acute kidney injury in neonates with a patent ductus arteriosus

2019 ◽  
Vol 40 (3) ◽  
pp. 510-514 ◽  
Author(s):  
Zachary Coffman ◽  
David Steflik ◽  
Shahryar M. Chowdhury ◽  
Katherine Twombley ◽  
Jason Buckley
Keyword(s):  
Acute Kidney Injury ◽  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Kidney Injury ◽  
Patent Ductus

scholarly journals The effect of chronic infection foci in the mother on the development of acute kidney injury in premature infants with hemodynamically significant patent ductus arteriosus

2020 ◽  
pp. 13-18
Author(s):  
T.P. Borysova ◽  
◽  
O.U. Obolonska ◽  
◽  
Keyword(s):  
Acute Kidney Injury ◽  
Patent Ductus Arteriosus ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Kidney Injury ◽  
Maternal Infection ◽  
Group Iii ◽  
Group I ◽  
Group Ii ◽  
Patent Ductus

Nephrogenesis may be disrupted antenatally because of chronic infection foci (CIF) in the mother, the development of chorioamnionitis, feto-placental insufficiency. As a result, in the postnatal period, the kidneys are more sensitive to hypoperfusion, which occurs in premature infants with hemodynamically significant patent ductus arteriosus (HSPDA) and can lead to the development of acute kidney injury (AKI). Purpose — to study the influence of CIF in the mother on the development of AKI in premature infants with HSPDA. Materials and methods. 74 premature infants (gestational age 29–36 weeks) who were treated in the Department of Anesthesiology and Neonatal Intensive Care MI «Dnepropetrovsk Regional Children's Clinical Hospital» Dnepropetrovsk Regional Council» were examined. Patients were divided into three groups depending on the presence of a patent ductus arteriosus (PDA) and its hemodynamic significance: Group I — 40 children with HSPDA, Group II — 17 children with PDA without hemodynamic disorders, Group III — 17 children with a closed ductus arteriosus. The presence of CIF in the mother was determined according to medical records, chorioamnionitis on the basis of histopathological examination of the placenta. Patients with HSPDA were divided into two subgroups: 28 children from mothers with CIF, 12 — without CIF. Clinical examination and treatment of premature infants was carried out according to generally accepted methods. Echocardiography with Doppler was performed at 5–11 hours of life and then daily to determine PDA, its size and hemodynamic significance. Diagnosis and stratification of the severity of AKI were performed according to the criteria of neonatal modification of KDIGO, for which the concentration of serum creatinine and diuresis were studied. Results. Chronic foci of infection were found in 28 (70.0%) mothers of group I, in 5 (29.4%) — group II, in 6 (35.2%) — group III. Chorioamnionitis in group I — 10 (25%) cases, in group II–ІII — 6 (17.6%). The presence of CIF in the mother caused a significant increase in the size of the PDA on the first day of life in the group of HSPDA against groups II–III: 2.61±0.861 (2.3; 2–3.5) mm against 1.79±0.365 (1.7; 1.5–2) mm, p<0.001. Patent arterial duct with a diameter of >2 mm on the first day of life in premature infants of group I from mothers with foci of infection was observed more often — 19 (67.9%) against 2(6.7%) of groups II–III (OR=10.56; CI: 1.9–58.53, p<0.005). Analysis of the incidence of AKI on the third day of life depending on HSPDA and the presence of CIF showed that 64.3% of preterm infants with HSPDA and maternal infection developed AKI — 6.6 times more often than in groups without HSPDA (OR=8.40; CI: 2.60–27.14; p<0.001), and 2.6 times more often compared to children of the subgroup HSPDA without recorded maternal infection (OR=5.40; CI: 1.18–24.65; p<0.03). On the background of HSPDA and CIF stage II–III AKI was observed in every third child. Comparative analysis within group I depending on the CIF revealed that the frequency of AKI for 10 days in the subgroup with infection was almost three times higher than the level of the subgroup without infection: 71.4% vs. 25.0% (OR=7.50; CI: 1.60–35.07; p<0.009). Conclusions. The presence of CIF in the mother is a risk factor for AKI in premature infants with HSPDA. Therefore, such children should be classified as at risk of developing AKI. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: acute kidney injury, chronic foci of maternal infection, hemodynamically significant patent ductus arteriosus, premature infants.

scholarly journals Changes in Serum Creatinine Levels and Natural Evolution of Acute Kidney Injury with Conservative Management of Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants at 23–26 Weeks of Gestation

2020 ◽  
Vol 9 (3) ◽  
pp. 699 ◽  
Author(s):  
Eun Seo ◽  
Se Sung ◽  
So Ahn ◽  
Yun Chang ◽  
Won Park
Keyword(s):  
Acute Kidney Injury ◽  
Patent Ductus Arteriosus ◽  
Serum Creatinine ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Kidney Injury ◽  
Adverse Outcomes ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
Patent Ductus

Changes in kidney function in extremely preterm infants (EPT) with conservatively managed hemodynamically significant (HS) patent ductus arteriosus (PDA) are not known well. We aimed to present the postnatal course in serum creatinine levels (sCr), prevalence of acute kidney injury (AKI), then relevance between AKI and adverse outcomes in EPT with conservatively managed HS PDA. By review of medical records, we analyzed the postnatal course of sCr and prevalence of stage 3 AKI defined by the modified Kidney Disease Improving Global Outcome (KDIGO) in EPT at gestational age of 23 to 26 weeks with conservatively treated HS PDA. We investigated if the presence and/or prolonged duration of stage 3 AKI elevated the risk of adverse outcomes. The results showed that, neither factor was associated with adverse outcomes. While the average PDA closure date was at postnatal day (P) 41 and 53, sCr peaked at P 10 and 14 and the cumulative prevalence of stage 3 AKI was 57% and 72% in the EPT of 25–26 and 23–24 weeks’ gestation, respectively. The high prevalence of stage 3 AKI without adverse outcomes in EPT with conservatively managed HS PDA suggests that it might reflect renal immaturity rather than pathologic conditions.

scholarly journals ACUTE KIDNEY INJURY IN PREMATURE CHILDREN WITH HEMODYNAMICALLY SIGNIFICANT OPEN ARTERIAL DUCT

2020 ◽  
Vol 10 (4(38)) ◽  
pp. 26-34
Author(s):  
T. Borysova ◽  
O. Obolonska ◽  
D. Surkov
Keyword(s):  
Acute Kidney Injury ◽  
Patent Ductus Arteriosus ◽  
Serum Creatinine ◽  
Premature Infants ◽  
Ductus Arteriosus ◽  
Kidney Injury ◽  
The Third ◽  
Premature Babies ◽  
Arterial Duct ◽  
Patent Ductus

Introduction. Hemodynamically significant patent ductus arteriosus (HSPDA) leads to the “steal” phenomenon of the systemic circulation and renal hypoperfusion, which can contribute to the development of acute kidney injury (AKI). Aim of the study. To assess the frequency and severity of AKI according to the criteria of neonatal modification of KDIGO in premature infants with HSPDA. Material and research methods. We examined 74 premature infants (gestational age 29-36 weeks) who were treated in the department of anesthesiology and intensive care of newborns. The duration of observation was ten days from the first day of life. The patients were divided into three groups depending on the presence of patent ductus arteriosus (PDA) and its hemodynamic significance: group I - 40 children with HSPDA, group II - 17 children with PDA without hemodynamic disorders, group III - 17 children with closed arterial duct. Clinical examination and treatment of premature infants was carried out according to the generally accepted methods. In HSPDA, ibuprofen was used to close the ductus arteriosus for 32 premature babies, and restrictive infusion therapy for 8 ones. Doppler echocardiography was performed at 5-11 hours of life and then daily to determine the PDA, its size and hemodynamic significance. Diagnosis and stratification of the severity of acute kidney injury were carried out according to the criteria of neonatal modification KDIGO, for which the concentration of serum creatinine was studied on the first, third, fifth, seventh, tenth days and the level of urine output every 6-12 hours. Research results. AKI on the third day of life was diagnosed in 52.5% of children with HSPDA, which is 2.2 times more often than in children with PDA without hemodynamic significance (p <0.05) and 4.4 times more often than with closed arterial duct (p<0.007). On the fifth day of life, AKI was detected in two more children and their total number increased to 57.5%. On the seventh and tenth days of life, AKI in children with HSPDA was more common than in children with a closed duct (50.0% versus 11.8%, p<0.008, and 29.4% versus 0%, p<0.02, respectively). Analysis of the severity of acute kidney injury showed the effect of HSPDA on this parameter. The presence of HSPDA was a factor that led to the development of stage II AKI on the third and fifth days of life. In addition, with HSPDA, the frequency of stage III AKI increased 2.7 times within four days, while the percentage of stages I-II AKI decreased by 1.5 times. The frequency and severity of AKI in children with HSPDA depended on the size of the ductus arteriosus. With PDA up to 2 mm in diameter, on the third and fifth days of life, AKI was diagnosed in every fifth patient of stage I only, and on the tenth day of life - only in one patient. Meanwhile, in the majority of children with a PDA diameter of more than 2 mm, AKI was diagnosed on the third, fifth and seventh days; only on the tenth day of life, the number of such patients decreased 1.3 times. But the proportion of severe acute kidney injury practically did not change - acute kidney injury of stages II-III was observed on the first day in every second child with a large PDA diameter. The serum creatinine level on the third and tenth days directly depended on the size of the PDA on the first day (ρ = 0.493, p˂0.001 and ρ = 0.432, p˂0.002, respectively). With HSPDA, this dependence was more pronounced (ρ = 0.732, p˂0.001 and ρ = 0.731, p˂0.001, respectively) than in the group with PDA without hemodynamic significance (ρ = 0.285, p<0.05 and ρ = 0.324, p>0.05, respectively). The serum creatinine concentration directly correlated with the closure time of the PDA. Analysis of the connection between the rate of closure of the PDA and the presence of AKI in the HSPDA group showed that in the case of late closure of the ductus arteriosus (at 3-5 days of life), 16 (94.1%) premature infants suffered from kidney damage versus 1 (5.9%) case among children, in which the duct closed in the first two days (OR = 36.57; CI: 4.02-332.34 p<0.001). A close correlation was also established between the rate of closure of the PDA and the maximum stage of the AKI (ρ = 0.700, p˂0.001). Conclusions. HSPDA contributes to the development of AKI in premature infants. The diameter and rate of closure of the ductus arteriosus determine the frequency and severity of AKI in premature infants with HSPDA. Additional research is needed to diagnose acute kidney injury in premature babies with HSPDA earlier.

scholarly journals Evaluation of the Risk Factors for Acute Kidney Injury in Neonates Exposed to Antenatal Indomethacin

2020 ◽  
Vol 25 (7) ◽  
pp. 606-616
Author(s):  
Jennifer T. Pham ◽  
Jessica L. Jacobson ◽  
Kirsten H. Ohler ◽  
Donna M. Kraus ◽  
Gregory S. Calip
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Patent Ductus Arteriosus ◽  
Bloodstream Infection ◽  
Proportional Hazards ◽  
Ductus Arteriosus ◽  
Kidney Injury ◽  
Cox Proportional Hazards ◽  
Increased Risk ◽  
Patent Ductus

OBJECTIVE Evidence is limited about important maternal and neonatal risk factors that affect neonatal renal function. The incidence of acute kidney injury (AKI) and identification of associated risk factors in neonates exposed to antenatal indomethacin was studied. METHODS A retrospective cohort of neonates exposed to antenatal indomethacin within 1 week of delivery was analyzed for development of AKI up to 15 days of life. Adjusted hazard ratios (HRs) and 95% CIs for AKI risk were calculated in time-dependent Cox proportional hazards models. RESULTS Among 143 neonates with mean gestational age of 28.3 ± 2.4 weeks, AKI occurred in 62 (43.3%), lasting a median duration of 144 hours (IQR, 72–216 hours). Neonates with AKI had greater exposure to postnatal NSAIDs (48.4% vs 9.9%, p &lt; 0.001) and inotropes (37.1% vs 3.7%, p &lt; 0.001) compared with neonates without AKI. In multivariable-adjusted models, increased AKI risk was observed with antenatal indomethacin doses received within 24 to 48 hours (HR, 1.6; 95% CI, 1.28–1.94; p = 0.036) and &lt;24 hours (HR, 2.33; 95% CI, 1.17–4.64; p = 0.016) prior to delivery. Further, postnatal NSAIDs (HR, 2.8; 95% CI, 1.03–7.61; p = 0.044), patent ductus arteriosus (HR, 4.04; 95% CI, 1.27–12.89; p = 0.018), and bloodstream infection (HR, 3.01; 95% CI, 1.37–6.60; p = 0.006) were associated significantly with increased risk of AKI following antenatal indomethacin. Neonates with AKI experienced more bloodstream infection, severe intraventricular hemorrhage, patent ductus arteriosus, respiratory distress syndrome, and longer hospitalization. CONCLUSIONS Extended risk of AKI with antenatal indomethacin deserves clinical attention among this population at an already increased AKI risk.

scholarly journals Acute kidney injury among preterm infants receiving non-steroidal anti-inflammatory drugs for patent ductus arteriosus

2020 ◽  
Author(s):  
Joseph Ting ◽  
Kate McDougal ◽  
Alanna De Mello ◽  
Eddie Kwan ◽  
Cherry Mammen
Keyword(s):  
Acute Kidney Injury ◽  
Treatment Group ◽  
Patent Ductus Arteriosus ◽  
Ductus Arteriosus ◽  
Kidney Injury ◽  
Prophylaxis Group ◽  
Increased Risk ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
Patent Ductus

Abstract Background: Nonsteroidal anti-inflammatory drugs (NSAID) are a frequently prescribed class of medication in the neonatal intensive care unit (NICU). Hospitalized patients receiving NSAID therapy are at an increased risk of acute kidney injury (AKI). Our primary objective was to reveal AKI epidemiology in NSAID-exposed premature infants admitted to the NICU using a standardized definition.Methods: This retrospective study included infants born at ≤34 weeks gestational age who received NSAID for intraventricular haemorrhage prophylaxis [“prophylaxis group”] or symptomatic treatment for patent ductus arteriosus (PDA) [“treatment group”] between January and December 2014 at British Columbia Women’s Hospital NICU. All available serum creatinine (SCr) and 12-hour urine output (UO) were recorded from admission till day 7 post NSAID exposure. AKI incidence was determined using the modified Kidney Disease: Improving Global Outcomes (KDIGO) classification with an increase in SCr (ΔSCr) (50% rise from prior SCr within 7 days or 26.5 mmol/L rise within 48 hours) and/or UO < 1 mL/kg/hour, excluding the first 24 h of life.Results: We identified 70 eligible subjects, 32 of whom received prophylactic NSAID (prophylaxis group), and 38 received indomethacin or ibuprofen for treatment of symptomatic PDA (treatment group), with an overall AKI incidence of 23% (16/70). The treatment group had a higher proportion of infants with SCr monitoring during the NSAID than the prophylaxis group (87% vs. 13%, p<0.001). Based upon the above defined criteria (fulfilling at least one—either the UO or SCr monitoring criteria), the prophylaxis group had a significantly lower AKI rate compared with the treatment group (9% vs. 34%; p=0.014). Conclusions: AKI incidence is higher in infants treated with NSAID for symptomatic PDA than in those treated prophylactically during the first day of life, based on the criteria applied. However, the burden of AKI may be underestimated in the prophylaxis group due to fewer available SCr values after exposure, and inability to utilize UO criteria in the 1st 24 hours of life. Standardized protocols for monitoring daily SCr and UO after exposure should be implemented for all neonates with NSAID exposure and should be considered to improve AKI recognition.

scholarly journals Effect of ibuprofen for hemodynamically significant patent ductus arteriosus closure on the development of acute kidney injury in preterm infants

2021 ◽  
Vol 26 (1) ◽  
pp. 156-162
Author(s):  
T.P. Borysova ◽  
O.Yu. Obolonska
Keyword(s):  
Acute Kidney Injury ◽  
Patent Ductus Arteriosus ◽  
Preterm Infants ◽  
Standard Dose ◽  
Ductus Arteriosus ◽  
Kidney Injury ◽  
High Dose ◽  
The Third ◽  
Renal Hypoperfusion ◽  
Patent Ductus

Premature infants with hemodynamically significant patent ductus arteriosus (HSPDA) have a high risk of developing acute kidney injury (AKI) due to renal hypoperfusion and use of ibuprofen for duct closure. The aim of the study was to evaluate the effect of ibuprofen for the closure of HSPDA on the development of AKI in preterm infants depending on high dose of the drug on the first day of life. 40 preterm infants with HSPDA who were admitted for observation on the first day of life were examined. To close the ductus arteriosus, infants received restrictive therapy. In addition, 32 (80,0%) preterm infants on the first day of life were prescribed ibuprofen: 19 infants – in high dose (20 mg/kg), 13 infants – in standard dose (10 mg/kg). Clinical examination and treatment of preterm infants was carried out according to the generally accepted methods. Echocardiography with Doppler was performed at 5-11 hours of life and then daily to determine the size and hemodynamic significance of patent ductus arteriosus. Diagnosis and stratification of the severity of AKI were performed according to the criteria of neonatal modification of KDIGO, for which the concentration of serum creatinine and diuresis were studied. According to the results of the study, it was established that the frequency of AKI on the third and fifth days of life in preterm infants with HSPDA, who received ibuprofen in a high dose (20 mg/kg) on the first day, was 73.7% and 84.2%, respectively, which is 2.2 (OR=5.6; CI: 1,43-21,95; р<0.02) and 2.5 (OR=10.67; CI: 2.31-49.31; р<0.002) times, more often than in infants without such therapy. High dose of ibuprofen on the first day of life in preterm infants with HSPDA are most often associated with the development of stage I AKI on the third or fifth day of life, which was temporary in one third of patients. The use of a high-dose ibuprofen for HSPDA closure on the first day of life in preterm infants was significantly more often associated with foci of infection in the mother, large duct size and furosemide use.

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