Elevation in plasma creatinine and renal failure in premature neonates without major anomalies: terminology, occurrence and factors associated with increased risk

Abstract

Objective: The goal of this study was to describe the changes in plasma creatinine levels that occur in prematurely born neonates, to better understand the use of the terms 'renal dysfunction' and 'renal failure' among premature neonates, as well as to evaluate the demographic and outcome characteristics associated with renal problems in preterm neonates who have no major congenital anomalies.

Study design: Retrospective review of the Pediatrix neonatal intensive care patient clinical data warehouse.

Result: The study cohort consisted of neonates born with an estimated gestational age of ≤ 30 completed weeks in whom there was no report of any major anomalies (n=66,526). In this group of 66,526 neonates, there were 64,030 (96.2%) with no report of renal dysfunction or failure, 1239 (1.9%) in whom there was a diagnosis of renal dysfunction and 1257 infants (1.9%) with a diagnosis of renal failure. The clinical circumstances most strongly associated with a diagnosis of renal dysfunction and/or renal failures were low gestational age and birth weight. In addition, multivariate analysis showed that the factors associated with an increased risk of renal problems were vasopressor use during the first 7 days after birth, grade 3 or 4 intraventricular hemorrhage, a patent ductus arteriosus, necrotizing enterocolitis, male gender, the use of indomethacin, a positive blood culture during the first 7 days after birth, the use of high-frequency ventilation in the first 2 days after birth, non-White race and prolonged exposure to antibiotics. Mortality was higher in patients with renal problems than in neonates without renal problems (39.1 vs 10.2%, P<0.01) and higher in neonates with renal failure than in neonates with renal dysfunction (57.6 vs 20.1%, P<0.01).

Conclusion: Renal dysfunction and/or failure are common diagnoses, especially in extremely premature neonates and there are potentially modifiable factors that increase the risk of renal problems.