Acute Kidney Injury in Neonates with Perinatal Asphyxia: A Descriptive Analysis

Introduction: Although acute kidney injury (AKI) is one of the complications of perinatal asphyxia, it is not well recognized morbidity in neonates. AKI based on serum creatinine and urine output assessments vary widely. We aimed to study the prevalence and characteristics of AKI among perinatally asphyxiated near term and term neonates. We also evaluated oliguric and non-oliguric AKI on day three of life and relationship of AKI to hypoxic-ischemic encephalopathy (HIE) stages. Further we compared mortality among asphyxiated neonates with and without AKI as well as mortality among oliguric AKI and non-oliguric AKI neonates. Methods: Neonates with gestation ≥ 35 weeks fulfilling the criteria of perinatal asphyxia were included in the study. The serum creatinine, electrolytes, urine output, presence of HIE and duration of hospital stay were studied. Results: A total of 67 perinatally asphyxiated neonates were studied. Oliguria was found in nine (13.4%) neonates on day two. Among them, six (66.6%) neonates had normal urine output and three (33.4%) continued to have oliguria by day three. On day three, AKI was found in 32 (47.8%) neonates which was oliguric in three (9.4%) and non-oliguric in 29 (90.6%). AKI was observed in 23 (44.2%) of 52 neonates with HIE, 60% of HIE stage I, 41% of HIE stage II and 33.3% of HIE stage III. Mortality among neonates with AKI was 6.3 (95% CI-0.7 to 57.1) times greater compared to neonates without AKI. A higher percentage of oliguric AKI neonates expired (2 / 3; 66.6%) compared to non-oliguric AKI neonates (3 / 29; 13.8%). Conclusions: Among asphyxiated neonates, AKI was observed in 48% on day three. AKI was mostly non-oliguric. AKI especially the oliguric type in asphyxiated neonates contributes to higher mortality.