Renal Regional Oxygen Saturation and Acute Kidney Injury in Neonates with Perinatal Asphyxia

Abstract

Objective Neonates with moderate-to-severe perinatal asphyxia often develop acute kidney injury (AKI). Additionally, therapeutic hypothermia (TH) can affect renal blood flow. This study aimed to evaluate the association between renal regional oxygen saturation (rSrO₂) during TH and AKI in neonates with moderate and severe perinatal asphyxia.

Study Design This retrospective longitudinal study included neonates with moderate-to-severe asphyxia who required TH. The primary outcome was the occurrence of AKI, classified as a rate of decrease in creatinine levels of <33% at 72 hours of TH. rSrO₂ was continuously monitored by near-infrared spectroscopy during the hypothermia and rewarming phases. Data analysis involved dividing the average rSrO₂ levels into 12-hour periods. We analyzed the association between AKI and rSrO₂ levels using univariate and multivariate logistic regression models. Furthermore, we assessed the predictive capacity of rSrO₂ for AKI by analyzing the area under the receiver operating characteristic curve.

Results Ninety-one patients were included in the study. On average, patients with AKI exhibit lower rSrO₂ levels during TH. Specifically, rSrO₂ levels within the first 12 hours and between 25 and 72 hours of TH demonstrated the highest predictive capability for AKI. Multivariate logistic regression analysis revealed that rSrO₂ levels within the initial 12 hours (adjusted odds ratio [aOR] = 1.11, 95% confidence interval [CI]: 1.01–1.21) and between 61 and 72 hours (aOR = 0.85, 95% CI: 0.78–0.92) were significantly associated with AKI.

Conclusion An increase in rSrO₂ during the first 12 hours of TH and lower rSrO₂ levels between 61 and 72 hours of treatment were associated with the development of AKI in asphyxiated neonates undergoing TH.

Key Points

• Neonates with asphyxia often develop AKI.

• Renal saturations are affected by hypothermia and asphyxia

• Patients with AKI initially show higher rSrO₂, then lower rSrO₂.

• Monitoring rSrO₂ identifies early AKI.

Keywords

acute kidney injury - asphyxia neonatorum - infant - newborn - renal regional oxygen saturation - therapeutic hypothermia - spectroscopy - near-infrared

Ethical Approval

The study protocol was approved by the Fundación Cardio Infantil—Instituto de Cardiología Ethics Committee (approval no.: CEIC-0602-2022).

Authors' Contributions

S.A-P.: Conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, supervision, validation, writing—original draft, writing—review and editing. G.T.: Conceptualization, formal analysis, methodology, resources, visualization, writing—original draft, writing—review and editing. D.B-R.: data curation, formal analysis, investigation, methodology, supervision, validation, writing—original draft, writing—review, and editing. C.M., A.R., A.V.G., and J.L.: Data curation, formal analysis, investigation, visualization, writing—original draft.

Data Availability

Additional datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Publication History

Received: 25 March 2024

Accepted: 17 July 2024

Accepted Manuscript online:
19 July 2024

Article published online:
13 August 2024

• References

• 1 Perin J, Mulick A, Yeung D. et al. Global, regional, and national causes of under-5 mortality in 2000-19: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet Child Adolesc Health 2022; 6 (02) 106-115
• 2 Herrera CA, Silver RM. Perinatal asphyxia from the obstetric standpoint: diagnosis and interventions. Clin Perinatol 2016; 43 (03) 423-438
• 3 Iribarren I, Hilario E, Álvarez A, Alonso-Alconada D. Neonatal multiple organ failure after perinatal asphyxia. An Pediatr (Engl Ed) 2022; 97 (04) 280.e1-280.e8
• 4 Dincer E, Topçuoğlu S, Keskin Çetinkaya EB. et al. Acute kidney injury in neonatal hypoxic-ischemic encephalopathy patients treated with therapeutic hypothermia: incidence and risk factors. Ther Hypothermia Temp Manag 2024; 14 (01) 31-35
• 5 Selewski DT, Charlton JR, Jetton JG. et al. Neonatal acute kidney injury. Pediatrics 2015; 136 (02) e463-e473
• 6 Gohiya P, Nadkarni J, Mishra M. Study of neonatal acute kidney injury based on KDIGO criteria. Pediatr Neonatol 2022; 63 (01) 66-70
• 7 Nada A, Bonachea EM, Askenazi DJ. Acute kidney injury in the fetus and neonate. Semin Fetal Neonatal Med 2017; 22 (02) 90-97
• 8 Starr MC, Charlton JR, Guillet R. et al; Neonatal Kidney Collaborative Board. Advances in neonatal acute kidney injury. Pediatrics 2021; 148 (05) e2021051220
• 9 Sood BG, McLaughlin K, Cortez J. Near-infrared spectroscopy: applications in neonates. Semin Fetal Neonatal Med 2015; 20 (03) 164-172
• 10 Harer MW, Chock VY. Renal tissue oxygenation monitoring-an opportunity to improve kidney outcomes in the vulnerable neonatal population. Front Pediatr 2020; 8: 241
• 11 Gabriel PJ, Gloria T, Carolina S, Eugenia E. Consenso De Expertos Diagnóstico, Manejo, Monitoreo Y Seguimiento Del Recién Nacido Con Asfixia Perinatal,. Encefalopatía Hipóxico Isquémica (EHI), E Hipotermia Terapeutica (HT). ASCON; 2021
• 12 Shankaran S, Laptook AR, Ehrenkranz RA. et al; National Institute of Child Health and Human Development Neonatal Research Network. Whole-body hypothermia for neonates with hypoxic-ischemic encephalopathy. N Engl J Med 2005; 353 (15) 1574-1584
• 13 Gupta C, Massaro AN, Ray PE. A new approach to define acute kidney injury in term newborns with hypoxic ischemic encephalopathy. Pediatr Nephrol 2016; 31 (07) 1167-1178
• 14 Chock VY, Frymoyer A, Yeh CG, Van Meurs KP. Renal saturation and acute kidney injury in neonates with hypoxic ischemic encephalopathy undergoing therapeutic hypothermia. J Pediatr 2018; 200: 232-239.e1
• 15 Rumpel JA, Spray BJ, Frymoyer A. et al. Renal oximetry for early acute kidney injury detection in neonates with hypoxic ischemic encephalopathy receiving therapeutic hypothermia. Pediatr Nephrol 2023; 38 (08) 2839-2849
• 16 Wu TW, Tamrazi B, Soleymani S, Seri I, Noori S. Hemodynamic changes during rewarming phase of whole-body hypothermia therapy in neonates with hypoxic-ischemic encephalopathy. J Pediatr 2018; 197: 68-74.e2
• 17 Aydın B, Okumuş N, Özkan MB, Zenciroğlu A, Dilli D, Beken S. Renal artery flow alterations in neonates with hypoxic ischemic encephalopathy. Pediatr Nephrol 2024; 39 (04) 1253-1261
• 18 Bruckner M, Wolfsberger CH, Dempsey EM, Liem KD, Lemmers P, Alderliesten T, Alarcon A, Mintzer J, de Boode WP, Schmölzer GM, Pichler G. ESPR Special Interest Group “Near InfraRed Spectroscopy” (NIRS).. Normal regional tissue oxygen saturation in neonates: a systematic qualitative review. Pediatr Res 2021; (e-pub ahead of pront).
• 19 Marin T, Williams BL, Mansuri A. et al. Renal oxygenation (rSO₂) population parameter estimates in premature infants routinely monitored with near-infrared spectroscopy. Adv Neonatal Care 2022; 22 (04) 370-377
• 20 Pefanis A, Ierino FL, Murphy JM, Cowan PJ. Regulated necrosis in kidney ischemia-reperfusion injury. Kidney Int 2019; 96 (02) 291-301
• 21 Ilves P, Lintrop M, Talvik I, Muug K, Maipuu L. Changes in cerebral and visceral blood flow velocities in asphyxiated term neonates with hypoxic-ischemic encephalopathy. J Ultrasound Med 2009; 28 (11) 1471-1480
• 22 Evans KM, Rubarth LB. Investigating the role of near-infrared spectroscopy in neonatal medicine. Neonatal Netw 2017; 36 (04) 189-195
• 23 Marin T, Williams BL. Renal oxygenation measured by near-infrared spectroscopy in neonates. Adv Neonatal Care 2021; 21 (04) 256-266