Characterizing dynamics of serum creatinine and creatinine clearance in extremely low birth weight neonates during the first 6 weeks of life

Abstract Background Characterizing the dynamics of serum creatinine concentrations (Scr) and associated creatinine clearance (CLcr) as a measure of kidney function in extremely low birth weight (≤ 1000 g; ELBW) neonates remains challenging. Methods We performed a retrospective study that included longitudinal Scr (enzymatic assay) data from 148 ELBW neonates up to 6 weeks after birth. Change of Scr and inter-individual variability was characterized with nonlinear mixed-effect modeling. Key covariates such as gestational age (GA), mode of delivery (MOD), and treatment with ibuprofen or inotropic agents were investigated. Results A total of 2814 Scr concentrations were analyzed. GA was associated with Scr at birth (higher with advancing GA), and GA and MOD showed an association with postnatal maturation of CLcr (faster clearance increase with advancing GA and after C-section). Small CLcr decrease (≤ 5%) was quantified during ibuprofen treatment. For a GA of 27 weeks, mean Scr (estimated CLcr) at birth was 0.61 mg/dl (0.23 ml/min), increasing to 0.87 mg/dl (0.27 ml/min) at day three, and decreasing to 0.36 mg/dl (0.67 ml/min) at day 42 after birth. Conclusions We report the first mathematical model able to characterize Scr and CLcr in ELBW neonates during the first 6 weeks of life in a quantitative manner as a function of GA, MOD, and ibuprofen treatment. This model allows the derivation of GA-adjusted reference ranges for ELBW neonates and provides a rationale for normative Scr concentrations, and as such will help clinicians to further optimize monitoring and treatment decisions in this vulnerable patient population.

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Amikacin or Vancomycin Exposure Alters the Postnatal Serum Creatinine Dynamics in Extreme Low Birth Weight Neonates

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020662 ◽

2021 ◽

Vol 18 (2) ◽

pp. 662

Author(s):

Tamara van Donge ◽

Anne Smits ◽

John van den Anker ◽

Karel Allegaert

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Serum Creatinine ◽

Potential Effect ◽

Extremely Low Birth Weight ◽

Treatment Modalities ◽

Antibiotic Exposure ◽

Sensitive Tool ◽

Elbw Neonates ◽

The Impact

Background: Disentangling renal adverse drug reactions from confounders remains a major challenge to assess causality and severity in neonates, with additional limitations related to the available tools (modified Kidney Disease Improving Global Outcome, or Division of Microbiology and Infectious Diseases pediatric toxicity table). Vancomycin and amikacin are nephrotoxic while still often prescribed in neonates. We selected these compounds to assess their impact on creatinine dynamics as a sensitive tool to detect a renal impairment signal. Methods: A recently developed dynamical model that characterized serum creatinine concentrations of 217 extremely low birth weight (<1000 g, ELBW) neonates (4036 observations) was enhanced with data on vancomycin and/or amikacin exposure to identify a potential effect of antibiotic exposure by nonlinear mixed-effects modelling. Results: Seventy-seven percent of ELBW patients were exposed to either vancomycin or amikacin. Antibiotic exposure resulted in a modest increase in serum creatinine and a transient decrease in creatinine clearance. The serum creatinine increase was dependent on gestational age, illustrated by a decrease with 56% in difference in serum creatinine between a 24 or 32-week old neonate, when exposed in the 3rd week after birth. Conclusions: A previously described model was used to explore and quantify the impact of amikacin or vancomycin exposure on creatinine dynamics. Such tools serve to explore minor changes, or compare minor differences between treatment modalities.

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Reticulocyte Count: The Forgotten Factor in Transfusion Decisions for Extremely Low Birth Weight Infants

American Journal of Perinatology ◽

10.1055/s-0041-1736598 ◽

2021 ◽

Author(s):

Daniel Nakhla ◽

Alla Kushnir ◽

Rafat Ahmed ◽

Vineet Bhandari ◽

Krystal Hunter ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Neonatal Intensive Care ◽

Reticulocyte Count ◽

Retrospective Chart Review ◽

Extremely Low Birth Weight ◽

Positive Trend ◽

Reference Ranges ◽

Low Birth Weight Infants ◽

Packed Red Blood Cells

Objective Extremely low birth weight (ELBW) infants often receive transfusions of packed red blood cells (PRBCs). Long-term outcomes of infants treated with liberal versus restricted transfusion criteria have been evaluated with conflicting results. Clinicians incorporate a reticulocyte count (RC) in their transfusion decisions. There is a lack of information on reference ranges for RCs in growing ELBW infants and whether infant's chronologic age or corrected gestational age (GA) generates a specific trend in the RCs. Our aim was to evaluate the levels of RCs obtained from ELBW infants over the course of the initial hospitalization. Study Design A retrospective chart review of ELBW infants treated in the neonatal intensive care unit (NICU) and had RCs performed. We analyzed the RCs to observe trends based on the chronologic age and corrected GA. Results A total of 738 RCs were analyzed. A positive trend in RCs that reached a peak at 32 to 34 weeks' corrected GA and then experienced a downward trend was observed. Conclusion Our report examines a very common hematologic test that is theoretically helpful but is in need of guidelines concerning the appropriate frequency of testing and its utility in making transfusion decisions in ELBW infants. Key Points

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Acute Problems of Prematurity: Balancing Fluid Volume and Electrolyte Replacements in Very Low Birth Weight (VLBW) and Extremely Low Birth Weight (ELBW) Neonates

Nephrology and Fluid/Electrolyte Physiology: Neonatology Questions and Controversies ◽

10.1016/b978-1-4160-3163-5.50016-6 ◽

2008 ◽

pp. 161-183

Author(s):

Stephen Baumgart

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Fluid Volume ◽

Extremely Low Birth Weight ◽

Elbw Neonates

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Radiological Studies in Very Low Birth Weight and Extremely Low Birth Weight Neonates: ‘ALARA’ Revisited

Journal of Tropical Pediatrics ◽

10.1093/tropej/fmz080 ◽

2019 ◽

Vol 66 (4) ◽

pp. 403-411

Author(s):

Surjit Damon Jeetoo ◽

Johan Smith ◽

Richard Denys Pitcher

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Diagnostic Imaging ◽

South African ◽

Best Practice ◽

Very Low Birth Weight ◽

Extremely Low Birth Weight ◽

Limited Data ◽

Resource Limited ◽

Elbw Neonates

Abstract Background Very low birth weight (VLBW) and extremely low birth weight (ELBW) neonates are particularly susceptible to the adverse effects of ionizing radiation. There are limited data on radiographic practice among this population in resource-limited environments. Aim To estimate cumulative effective dose (ED) from diagnostic imaging in VLBW (1000–1500 g) and ELBW (<1000 g) neonates in a resource-limited setting. Method A retrospective analysis of all diagnostic imaging examinations performed on ELBW and VLBW neonates born in a large South African public-sector tertiary-level hospital from January through June 2015. Data were stratified by birth weight and imaging examination. The ED was estimated according to the method of Puch-Kapst. Non-parametric t-tests compared the number of radiographs and ED in VLBW and ELBW neonates, at 5% significance. Results Three hundred and ninety-three neonates with median birth weight 1130 (IQR: 930–1340) g were included; 265 (67%) were VLBW and 128 (33%) ELBW; 48 (12%) died at a median of 7 (IQR: 2–17) days. A median of 2 (IQR: 1–5) radiographs were performed per neonate, with median ED 28.8 (IQR: 14.4–90.8) μSv. The median radiographic exposures for VLBW and ELBW neonates were 1 (IQR: 1–4) and 4 (IQR: 2–9), respectively, (p < 0.0001) with median ED 14.4 (IQR: 14.4–70.4) μSv and 71.2 (IQR: 28.8–169.3) μSv, respectively, (p < 0.0001). Radiographic exposure for VLBW neonates was lower than previously documented for this population. Conclusion Neonatal radiographic practice in resource-limited settings has the potential to contribute to the discourse on international best practice.

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Vancomycin Prophylaxis for Late-Onset Sepsis in Very Low and Extremely Low Birth Weight Neonates

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.27.5.351 ◽

2008 ◽

Vol 27 (5) ◽

pp. 351-354 ◽

Cited By ~ 1

Author(s):

Susan Givens Bell

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Late Onset ◽

Bloodstream Infections ◽

Extremely Low Birth Weight ◽

Causative Organism ◽

Published Data ◽

Late Onset Sepsis ◽

Elbw Neonates ◽

Central Catheters

LATE-ONSET SEPSIS AMONG very low birth weight (VLBW) and extremely low birth weight (ELBW) neonates is a troubling occurrence. The most recently published data from the National Nosocomial Infection Surveillance system documents 5.4 umbilical- and central line–related bloodstream infections (BSIs) per 1,000 catheter days in infants weighing between 1,001 and 1,500 g.1 For infants weighing 1,000 g or less, the rate is 9.1 infections per 1,000 catheter days. A variety of factors, including prematurity and related relative immunocompromise, altered skin integrity, and multiple invasive procedures, places VLBW and ELBW neonates at risk for infection. Tunneled central catheters or peripherally inserted central catheters (PICCs) clearly add to the risk of infection in these vulnerable patients. In a point prevalence survey of a network of 29 NICUs, researchers found that coagulase-negative Staphylococcus (CoNS) was the causative organism in nearly half (48.3 percent) of the documented bloodstream infections.2 Vancomycin prophylaxis is a potential strategy for the prevention of late-onset sepsis associated with CoNS. This column explores the efficacy and safety of this strategy.

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Prenatal Steroid (PNS) Prevents Non-Oliguric Hyperkalemia In Extremely Low Birth Weight (ELBW) Neonates < 1000 Grams • 1084

Pediatric Research ◽

10.1203/00006450-199804001-01105 ◽

1998 ◽

Vol 43 ◽

pp. 186-186

Author(s):

Said A Omar ◽

Joseph D DeCristofaro ◽

Edmund F LaGamma ◽

Bajarang L Agarwal

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Extremely Low Birth Weight ◽

Elbw Neonates

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Can Early Clinical Status Predict Outcomes in Extremely Low Birth Weight Neonates?

Journal of Child Science ◽

10.1055/s-0040-1713659 ◽

2020 ◽

Vol 10 (01) ◽

pp. e32-e37

Author(s):

Alok Kumar MK ◽

Femitha Pournami ◽

Sujith Kumar Reddy Gurram Venkata ◽

Anand Nandakumar ◽

Jyothi Prabhakar ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Neonatal Intensive Care ◽

Clinical Status ◽

Strong Association ◽

Extremely Low Birth Weight ◽

Perinatal Factors ◽

Elbw Neonates ◽

Fraction Of Inspired Oxygen ◽

Inspired Oxygen

Abstract Background Extremely low birth weight (ELBW) neonates are the sickest patrons of neonatal intensive care. Authors have attempted to predict outcomes based on perinatal factors very soon after birth. Allowing a longer duration for clinical assessment may permit meaningful assessments. Postponing these predictions to several weeks does not offer succour. Methods We retrospectively studied association of predefined perinatal factors and clinical status of 53 ELBW infants in the first 72 hours of life; with death or continued need for respiratory support at 4 weeks of life separately (RS4). Results Mean and standard deviations of birth weight and gestational age were 781.8 (±130.7) g (range: 510–990 g) and 26.4 (±1.5) weeks (range: 24–30 weeks), respectively; 32.9% were < 750 g at birth. Of the 53 neonates, 20.7% babies expired and 47.1% required RS4 (66% neonates suffered composite outcome of death/RS4). Need for > 0.3 fraction of inspired oxygen (FiO2) beyond 72 hours of life demonstrated strong association with death/RS4 (odds ratio [OR] 14.3; 95% confidence interval [CI] 3.2–63.0). Need for chest compression (OR 15.3; 95% CI 1.4–167.2) and shock (OR 14.2; 95% CI 2.7–72.8) were significantly associated with mortality. Conclusion FiO2 requirement of > 0.3 at 72 hours reasonably predicts death or dependence on respiratory supports at 4 weeks of life.

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Reticulocyte Count: The Forgotten Factor in Transfusion Decisions for Extremely Low Birth Weight Infants

American Journal of Perinatology ◽

10.1055/a-1653-4585 ◽

2021 ◽

Author(s):

Daniel Nakhla ◽

Alla Kushnir ◽

Rafat Ahmed ◽

Vineet Bhandari ◽

Krystal Hunter ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Gestational Age ◽

Reticulocyte Count ◽

Retrospective Chart Review ◽

Extremely Low Birth Weight ◽

Positive Trend ◽

Reference Ranges ◽

Low Birth Weight Infants ◽

Packed Red Blood Cells

Background: Extremely low birth weight (ELBW) infants often receive transfusions of packed red blood cells. Long-term outcomes of infants treated with liberal versus restricted transfusion criteria have been evaluated with conflicting results. Clinicians incorporate a reticulocyte count (RC) in their transfusion decisions. There is a lack of information on reference ranges for RCs in growing ELBW infants and whether infant’s chronologic age or corrected gestational age generates a specific trend in the RCs. Objective: Our aim was to evaluate the levels of RCs obtained from ELBW infants over the course of the initial hospitalization. Study Design: A retrospective chart review of ELBW infants treated in the neonatal intensive care unit and had RCs performed. We analyzed the RCs to observe trends based on the chronologic age and corrected gestational age. Results: A total of 738 RCs were analyzed. A positive trend in RCs that reached a peak at 32-34 weeks corrected gestational age and then experienced a downward trend was observed. Conclusions: Our report examines a very common hematologic test that is theoretically helpful but is in need of guidelines concerning the appropriate frequency of testing and its utility in making transfusion decisions in ELBW infants.

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