Renal Functions in Relation to Severity of Perinatal Asphyxia in Term Neonates

Abstract

Introduction: Kidney is one of the most important organs commonly involved in the multiple organ dysfunction caused by perinatal asphyxia. Monitoring the serum urea, creatinine and urine output helps in early assessment of severity of perinatal asphyxia and, thus improving the outcome. Aim: To study renal functions in perinatal asphyxia and various stages of Hypoxic-Ischemic Encephalopathy (HIE) in term neonates. Materials and Methods: This observational study included 118 full-term perinatally asphyxiated neonates admitted in Neonatal Intensive Care Unit (NICU) of Uttar Pradesh University of Medical Sciences, Saifai, Etawah. Serum urea, creatinine and urine output were assessed on 1st, 3rd and 10th day of admission. A total of 48 newborns with normal Renal Function Test (RFT) and urine output were kept in Group A, while 70 newborn with abnormal RFT and urine output were kept in Group B. To compare RFT in various HIE stages of perinatal asphyxia, neonates were graded by the Levene staging system and divided in mild HIE (stage I), moderate HIE (stage II) and severe HIE (stage III). A total of 52 neonates who did not fulfill criteria of any stage of Levene were diagnosed as asphyxia without HIE and were excluded from comparison. Results: Significant differences (p-value <0.05) in serum urea, creatinine and urine output were found between Group A and B on postnatal day 1, 3 and 10. Total 66 neonates were diagnosed to have HIE with various grades (Stage I-15, Stage II-32 and Stage III-19). Rest 52 neonates were suffering from perinatal asphyxia but did not come in any category of HIE. On day 1, there was an increasing trend in concentration of both serum urea and serum creatinine as HIE staging progressed from HIE I to HIE III. On Day 3, serum urea and creatinine were found to be significantly higher in HIE III compare to HIE II. On day 10, serum urea and creatinine were significantly higher in HIE III as compared to HIE I and II. In all three days, urine output decreased as HIE stages progressed to I to III. Conclusion: Renal dysfunction correlates well with increasing severity of asphyxia in terms of HIE staging and it can be used as a marker to assess the severity of perinatal asphyxia.

Keywords

• hypoxic ischemic encephalopathy
• renal dysfunction
• serum creatinine
• serum urea