International Journal of Medical and Health Research

International Journal of Medical and Health Research


International Journal of Medical and Health Research
International Journal of Medical and Health Research
Vol. 6, Issue 7 (2020)

Renal profile of sick neonates admitted to NICU of a tertiary care centre


Khodaija Mahvish, Nikki Kumari, Binod Kumar Singh, Girijanand Jha

Background: Sick neonates suffer from variable degree of renal impairment and AKI is a frequent phenomenon in NICU. The cause of AKI is of multi-factorial etiology and usually, there are one or more associated contributing factors. Early recognition of renal failure is important to facilitate appropriate fluid and electrolyte management & a stable biochemical milieu to prevent permanent renal damage. Methodology: We conducted a prospective observational study at NICU of our tertiary care hospital, Nalanda Medical College & Hospital, Patna over 15 months from March 2019 to May 2020. Sick babies of gestational age ≥26 weeks and birth weight ≥800 gram admitted in NICU were included in the study & their kidney function was monitored. AKI was defined as per serum creatinine &/or urine output criteria. Results: 459 neonates were studied out of which 57 (12.4%) suffered from AKI. Mean gestational age of neonates with AKI was 33.4 (S. D=4.4) and mean weight on admission was 2.172 Kg (S. D= 0.840 kg). Male: female ratio was 1.48:1. Out of theses neonates with AKI, a diagnosis AKI was made by 24 hours of admission in 34(59.6%) and in the rest 23 (40.4%) neonates, it occurred after 24 hours of admission. The most common type of AKI was pre-renal type which accounted for 73.7% (n=42) of cases. Intrinsic renal and post-renal causes accounted for 19.3% (n=11) and 7.02% (n=4) cases respectively. The common predisposing factors were sepsis (61.4%), asphyxia (49.1%), shock (54.4%) and dehydration (12.3%). Oliguric renal failure was seen in 25 (43.9%) cases and the underlying etiology did not play a role in the occurrence of oliguria. Out of the 57 neonates with AKI, 21 (36.9%) died. No difference in mortality was observed on the basis of sex, prematurity, SGA, birth asphyxia, dehydration, hyponatremia, hyperkalemia or metabolic acidosis. However, in this study we found a significantly higher mortality in the presence of sepsis, oliguria, higher mean serum creatinine level, and need of mechanical ventilation. Conclusion: AKI is a common phenomenon complicating the management of sick neonates with almost 1 in every 8 neonates admitted to our NICU suffering from this condition. As pre-renal AKI was the commonest type, this underscores that prompt recognition and management of hypoperfusion can prevent progression from pre-renal to intrinsic renal type of AKI. Most of such unfortunate neonates had more than 1 predisposing factors & sepsis and perinatal asphyxia were the most common risk factors for AKI. As non-oliguric AKI was more common than oliguric AKI, there was a high probability of missing 3 out of 5 cases with AKI if the focus was only on the urine output of a sick neonate. The presence of sepsis, oliguria, higher mean serum creatinine level, and use of mechanical ventilation were more commonly associated with mortality in such neonates.
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