Summary:
Introduction: Kidney is the 2nd commonest affected organ
as a consequence of asphyxia1. Most attention is given to
prevent CNS damage and neurological sequel but hypoxic
renal insult not only influences neonatal morbidity &
mortality but may give rise to CKD. to assess the renal
functional status of asphyxiated babies.
Material & Methods: This cross sectional study was
conducted in the Department of Neonatology & Department
of Gynecology and Obstetrics, Dhaka Medical College
Hospital during January 2012 to January 2013. A total of
150 inborn, term asphyxiated neonates with e” 2.5 kg who
had history of delayed or no cry with Apgar score <7 at 5
minutes were enrolled. Then, the cases were grouped into
mild (AS: 6-7), moderate (AS: 4-5) and severe asphyxia (AS:
0-3) based on Apgar score. Forty eight neonates were
excluded according to exclusion criteria. Finally, the renal
functions were assessed among 102 neonates by measuring
urine output 8 hourly and estimated creatinine clearance
(eCCL) on the 3rd day of life using Schwartz formula
(eCCl=Height (cm) ×.37/S.creatinine). Neonates with
impaired renal function were further classified as stage-I
(risk), II (injury), III (failure) using pRIFLE criteria. Data
were analyzed by Chi-square & Pearson correlation
coefficient test to find out correlation between Apgar scores
and renal functional status.
Results: Of the 102 cases studied, majority 48% were in
moderate, 30.4% in mild and 21.6% in severely asphyxiated
group. In the mild asphyxiated group 58.06% had normal
renal function. However, the remaining cases 29.03% &
12.90% had stage I, stage II renal injury respectively and
had no renal failure. In Moderately asphyxiated group,
26.53% had normal renal function & the remaining 32.65%,
34.69%, 6.1% had stage I, II, III renal injury respectively.
None of the severely asphyxiated babies had normal renal
function. However they had impaired renal function ranging
from Stage I (27.27%), stage II (27.27%) & stage III
(40.90%).Variable proportion of kidney injuries were noted
among the asphyxiated neonates. The lower the Apgar score,
the more severe the injuries and association between stages
of kidney injuries and Apgar score was observed statistically
significant (p<0.001). The renal functional status (eCCL)
was also found positively correlated with low Apgar score
(r=0.6, p<0.002).
Conclusion: Variable functional impairment of kidneys was
found among the asphyxiated neonates and the severity of
impairment significantly correlated with low Apgar score.
Key wards: Perinatal asphyxia, apgar score, Acute kidney
injury.
(J Bangladesh Coll Phys Surg 2017; 35: 128-132)