ESPN 51th Annual Meeting

ESPN 2018


 
AKI IN INFANTS WITH HYPOTHERMIA-TREATED HYPOXIC-ISCHAEMIC ENCEPHALOPATHY
KATARINA ROBERTSSON GROSSMANN Milan Chromek 1 Peter Bárány 1 Mats Blennow 1

1- Division of pediatrics, Department of clinical science, intervention and technology, Karolinska Institutet and Karolinska University Hospital
 
Introduction:

Perinatal asphyxia is a major cause of neonatal acute kidney injury (AKI), occurring in 47-72 % of infants with severe asphyxia. In the last decade, hypothermia treatment (HT) has become standard of care for neuroprotection in infants with post-asphyxial hypoxic-ischaemic encephalopathy (HIE). HT has been shown not to have a protective effect in adult AKI, but little is known about the effects of hypothermia in neonatal AKI. This retrospective population-based study investigates the incidence of AKI in hypothermia-treated infants with HIE.

Material and methods:

Term or near-term infants with post-asphyxial HIE underwent HT in addition to standard neonatal intensive care. Core body temperature was reduced to 33.5 degrees Celsius for 72 hours followed by slow rewarming. Creatinine values (baseline, day 1, 2, 3, 5, 7 and 10 if available) were reviewed retrospectively. Patients were classified as having developed AKI if there was ≥ 50 % increase in serum-creatinine from baseline (modified AKI network, AKIN definition) or if serum-creatinine rose above 133 µmol/L at any point (Chevalier definition). 

Results:

Between January 2007 and December 2009, 66 infants with post-asphyxial HIE underwent HT at Karolinska University Hospital, Stockholm. 8 infants (12 %) developed AKI according to AKIN-definition. When using either AKIN or Chevalier-definitions for AKI, 17 infants (25,8 %) fulfilled criteria for AKI. 1 infant needed CVVHDF-treatment for <1 week, the remaining 16 infants were treated conservatively. Overall, 7 infants did not survive to discharge from the NICU. The mortality in the AKI group was 17.6 % compared with 8.2 % in the non-AKI group (p = 0.15). 

Conclusions:

The incidence of neonatal AKI in our cohort was lower than in similar studies in the pre-hypothermia era. The morbidity and mortality in infants with AKI remain high and we therefore advocate for early recognition of AKI and intervention in this group of patients.