Changes in Serum Creatinine Levels and Natural Evolution of Acute Kidney Injury with Conservative Management of Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants at 23–26 Weeks of Gestation
Abstract
:1. Introduction
2. Experimental Section
2.1. Study Sample
2.2. AKI
2.3. HS PDA
2.4. Fluid Therapy
2.5. Data Collection and Definition
2.6. Statistical Analyses
3. Results
3.1. Natural Course of sCr
3.2. AKI Prevalence
3.3. Clinical Characteristics According to AKI Stage
3.4. Adverse Outcomes According to AKI Stage
3.5. Adjusted ORs for Risk of Adverse Outcomes by AKI Stage 3
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Stage | Serum Creatinine | GA 23–24 Weeks n = 50 | GA 25–26 Weeks n = 47 | Total n = 97 | Total with Oliguria (<0.5 mL/kg/day) n = 97 |
---|---|---|---|---|---|
0 | No change in SCr or rise < 0.3 mg/DL | 4 (8%) | 3 (6%) | 7(7%) | 1(1%) |
1 | SCr rise ≥ 0.3 mg/dL within 48 h or SCr rise ≥ 1.5–1.9 × reference SCr a within 7 days | 2 (4%) | 5 (11%) | 7(7%) | 1(1%) |
2 | SCr rise ≥ 2.0–2.9 × reference SCr a | 7 (14%) | 11 (23%) | 18(19%) | 1(1%) |
3 | SCr rise ≥ 3 × reference SCr a or SCr ≥ 2.5 mg/dL b or receipt of dialysis | 36 (72%) | 27 (57%) | 63(66%) | 18(19%) |
Clinical Characteristics | Total (n = 97) | |||||
---|---|---|---|---|---|---|
GA 23–24 Weeks (n = 50) | GA 25–26 Weeks (n = 47) | Total (n = 97) | ||||
AKI 0–2 (n = 13) | AKI 3 (n = 36) | AKI 0–2 (n = 18) | AKI 3 (n = 27) | AKI 0–2 (n = 31) | AKI 3 (n = 63) | |
Gestational age (weeks) | 23.9 ± 0.4 | 23.6 ± 0.5 | 25.6 ± 0.5 † | 25.3 ± 0.4 † | 24.8 ± 1.0 | 24.3 ± 1.0 * |
Birth weight, mean (SD), g | 684 ± 90 | 636 ± 79 | 743 ± 145 | 829 ± 140 † | 718 ± 127 | 719 ± 145 |
Male, n (%) | 6(46) | 19(53) | 7(39) | 19(70) * | 13(42) | 38(60) |
Apgar score at 1-min | 3.9 ± 0.7 | 4.2 ± 1.3 | 4.4 ± 1.8 | 4.7 ± 1.4 | 4.2 ± 1.4 | 4.4 ± 1.4 |
Apgar score at 5-min | 6.9 ± 1.1 | 6.5 ± 1.4 | 6.8 ± 1.4 | 6.9 ± 1.5 | 6.8 ± 1.3 | 6.7 ± 1.5 |
Cesarean delivery, n (%) | 8 (62) | 2 6(72) | 16 (89) | 24 (89) | 24 (78) | 50 (79) |
Hypertension in pregnancy, n (%) | 0 | 0 | 1 (6) | 0 | 1 (3) | 0 |
Chorioamnionitis, n (%) | 6 (46) | 25 (69) | 9 (50) | 15 (56) | 15 (48) | 40 (62) |
Use of inotropic drugs, n (%) | 3 (23) | 8 (22) | 4 (22) | 1 (4) | 7 (44) | 9 (56) |
Antenatal steroid use, n (%) | 12 (92) | 27 (75) | 13 (72) | 24 (89) | 25 (81) | 51 (81) |
Oliguria, n (%) | 1 (8) | 9 (25) | 1 (6) | 9 (33) * | 2 (7) | 18 (29) * |
Adverse Outcomes | Total (n = 97) | |||||
---|---|---|---|---|---|---|
GA 23–24 Weeks (n = 50) | GA 25–26 Weeks (n = 47) | Total (n = 97) | ||||
AKI 0–2 (n = 13) | AKI 3 (n = 36) | AKI 0–2 (n = 18) | AKI 3 (n = 27) | AKI 0–2 (n = 31) | AKI 3 (n = 63) | |
Mortality, n (%) | 1 (8) | 7 (19) | 1 (6) | 1 (4) | 2 (7) | 8 (13) |
Length of stay | 111 ± 14 | 120 ± 64 | 130 ± 68 | 110 ± 59 | 122 ± 53 | 116 ± 62 |
NEC (Stage ≥ 2b), n (%) | 0 | 5 (14) | 2 (11) | 3 (11) | 2 (7) | 8 (13) |
ROP (requiring laser operation), n (%) | 3 (23) | 10 (28) | 5 (28) | 7 (26) | 8 (26) | 17 (27) |
Blood culture-proven sepsis, n (%) | 3 (23) | 13 (36) | 1 (6) | 10 (37) * | 4 (13) | 23 (37) * |
Cystic PVL, n (%) | 3 (23) | 7 (20) | 3 (17) | 2 (7) | 6 (19) | 9 (15) |
IVH (Grade ≥ 3), n (%) | 1 (8) | 8 (22) | 1 (6) | 2 (7) | 2 (7) | 10 (16) |
BPD (≥moderate BPD), n (%) | 5 (39) | 15 (47) | 6 (33) | 8 (30) | 11 (36) | 23 (39) |
Survival without BPD, n (%) | 1 (0) | 0 | 1 (6) | 3 (11) | 2 (7) | 3 (5) |
Outcomes | Adjusted OR (95% CI) | p Value |
---|---|---|
Mortality | 0.965 (0.140–6.661) | 0.971 |
BPD (more than moderate BPD) | 1.441 (0.507–4.095) | 0.493 |
Survival without BPD | 0.314 (0.018–5.559) | 0.430 |
IVH (Grade ≥ 3), n (%) | 1.923 (0.360–10.269) | 0.444 |
Cystic PVL | 0.460 (0.116–1.819) | 0.268 |
ROP (requiring laser operation), n (%) | 1.538 (0.480–4.926) | 0.469 |
NEC (Stage ≥ 2b), n (%) | 3.610 (0.439–29.654) | 0.232 |
Blood culture-proven sepsis | 3.556 (0.965–13.101) | 0.057 |
Outcomes | Adjusted OR (95% CI) | p Value |
---|---|---|
Mortality | 1.040 (0.602–1.797) | 0.887 |
BPD (more than moderate BPD) | 1.043 (0.745–1.459) | 0.808 |
Survival without BPD | 0.332 (0.083–1.329) | 0.119 |
IVH (Grade ≥ 3), n (%) | 1.164 (0.074–1.823) | 0.508 |
Cystic PVL | 0.709 (0.437–1.150) | 0.163 |
ROP (requiring laser operation), n (%) | 1.000 (0.693–1.441) | 0.998 |
NEC (Stage ≥ 2b), n (%) | 1.325 (0.748–2.346) | 0.335 |
Blood culture-proven sepsis | 1.170 (0.820–1.665) | 0.382 |
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Seo, E.S.; Sung, S.I.; Ahn, S.Y.; Chang, Y.S.; Park, W.S. Changes in Serum Creatinine Levels and Natural Evolution of Acute Kidney Injury with Conservative Management of Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants at 23–26 Weeks of Gestation. J. Clin. Med. 2020, 9, 699. https://doi.org/10.3390/jcm9030699
Seo ES, Sung SI, Ahn SY, Chang YS, Park WS. Changes in Serum Creatinine Levels and Natural Evolution of Acute Kidney Injury with Conservative Management of Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants at 23–26 Weeks of Gestation. Journal of Clinical Medicine. 2020; 9(3):699. https://doi.org/10.3390/jcm9030699
Chicago/Turabian StyleSeo, Eun Seop, Se In Sung, So Yoon Ahn, Yun Sil Chang, and Won Soon Park. 2020. "Changes in Serum Creatinine Levels and Natural Evolution of Acute Kidney Injury with Conservative Management of Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants at 23–26 Weeks of Gestation" Journal of Clinical Medicine 9, no. 3: 699. https://doi.org/10.3390/jcm9030699