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Effect of thyroxine administration on renal functions in newborn infants with perinatal asphyxia
K Adamovich1, Z Baranyai, J P Guignard
1Department of Pediatrics, University Medical School, Pécs.
Insights
Thyroxine treatment accelerated kidney function recovery in newborns with perinatal asphyxia. This thyroid hormone therapy improved renal parameters compared to standard care, suggesting a vital role in neonatal recovery.
Area of Science:
- Neonatal Medicine
- Pediatric Nephrology
- Endocrinology
Background:
- Perinatal asphyxia significantly impairs renal function in neonates.
- Compromised kidney function in asphyxiated newborns includes elevated plasma waste products and reduced glomerular filtration rate (GFR).
- Asphyxia affects tubular function, indicated by altered urinary excretion and depressed aldosterone responsiveness.
Purpose of the Study:
- To evaluate the effect of thyroxine on renal function recovery in neonates with perinatal asphyxia.
- To assess if thyroxine administration improves respiratory adaptation and subsequent kidney function.
Main Methods:
- Two groups of asphyxiated neonates were studied: one received conventional therapy (Group I), and the other received conventional therapy plus thyroxine (Group II).
- Renal function was assessed on days 1, 7, and 14 by measuring plasma creatinine, uric acid, xanthine, hypoxanthine, GFR, urinary N-acetyl-β-D-glucosaminidase (NAGA), urine osmolality, fractional excretion of sodium (FENa), fractional excretion of calcium (FECa), renal flow index (RFI), and tubular response to aldosterone (TTKG).
- Results were compared to a control group of healthy neonates (Group III).
Main Results:
- Asphyxiated neonates showed significantly higher plasma levels of uric acid, xanthine, hypoxanthine, and creatinine, and markedly reduced GFR compared to controls.
- Elevated urinary NAGA, urine osmolality, FENa, FECa, RFI, and depressed TTKG were observed in asphyxiated infants.
- Thyroxine therapy in Group II led to accelerated renal functional recovery, evidenced by lower plasma creatinine, reduced fractional electrolyte and NAGA excretion, and improved aldosterone responsiveness on days 7 and/or 14 compared to Group I.
Conclusions:
- Thyroxine administration appears to accelerate the recovery of compromised renal functions in neonates suffering from perinatal asphyxia.
- Thyroid hormones may play a crucial role in the renal functional recovery process following perinatal asphyxia.
- Further research is warranted to elucidate the precise mechanisms and optimize thyroxine's therapeutic role in neonatal renal recovery.
Abstract:
The study was undertaken to assess the influence of thyroxine given to improve respiratory adaptation in asphyxiated neonates on the recovery of compromised renal functions. Two groups of infants with perinatal asphyxia were selected for the study. Group I consisted of 8 infants treated conventionally, while Group II included 7 infants who in addition to standard therapy were administered 50 micrograms thyroxine at admission and repeated 24 hours later. Their respective mean gestational ages were 38.7 weeks (range: 34-42 weeks) and 37.4 weeks (range: 34-41 weeks). The studies were performed on days 1, 7 and 14 and the results compared to those obtained in 13 healthy neonates with the gestational age of 39.2 weeks (range: 38-41 weeks) (Group III). Asphyxiated neonates had significantly higher plasma uric acid, xanthine, hypoxanthine and creatinine levels (p < 0.05), while their GFR proved to be markedly reduced (p < 0.01) when compared to the values of healthy controls. Moreover, there was a significant elevation of urinary excretion of NAGA (p < 0.001), urine osmolality (p < 0.05), PENa, FECa, RFI (p < 0.05) in infants presenting with perinatal asphyxia. Renal tubular responsiveness to aldosterone measured as TTKG was also found to be depressed (p < 0.025). In response to thyroxine therapy renal functional recovery appeared to be accelerated as indicated by the lower plasma creatinine level, lower rate of fractional electrolyte and urinary NAGA excretion and improved reactivity to aldosterone on days 7 and/or 14 as compared to those obtained in neonates presenting with asphyxia but without thyroxine therapy. The results seem to suggest that thyroid hormones may have an important role in the recovery of renal functions in newborn infants suffering from perinatal asphyxia.