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Published on: July 18, 2014
Altered in utero kidney development in newborns with congenital heart disease
Gemma B Scholes1, Diana Zannino2, Joshua Y Kausman3
1Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia.
Insights
Newborns with congenital heart disease (CHD) do not experience impaired kidney growth; instead, their kidneys are significantly larger than normal. The clinical implications of this finding require further investigation.
Area of Science:
- Pediatric Cardiology
- Fetal Development
- Neonatal Health
Background:
- Congenital heart disease (CHD) affects multiple organs, causing growth restriction in the brain and body.
- The brain-sparing phenomenon in fetuses with CHD prioritizes blood flow to the brain.
- This study investigated the impact of CHD and brain-sparing on fetal kidney growth.
Purpose of the Study:
- To test the hypothesis that impaired fetal kidney growth occurs in neonates with CHD.
- To analyze kidney size in newborns diagnosed with congenital heart disease.
Main Methods:
- Retrospective analysis of preoperative ultrasound kidney length measurements from 452 neonates undergoing CHD surgery.
- Kidney length percentiles were calculated using regression analysis against normative data based on gestational age and birthweight.
Main Results:
- Neonates with CHD exhibited significantly enlarged kidneys, with mean percentile ranging from 54.1-72.7.
- Kidneys were consistently larger than normal in neonates with left heart obstruction.
- Neonates with cyanotic heart disease showed normal or enlarged kidneys, depending on the reference population.
Conclusions:
- Kidneys of newborns with congenital heart disease are not smaller than average; they are, on average, larger.
- The clinical significance and underlying reasons for this kidney size discrepancy in CHD patients remain undetermined.
Background:
It is known that the heart is not the only organ affected in congenital heart disease (CHD); there is growth restriction of both the brain and the whole body. The protective mechanism of "the brain-sparing phenomenon" re-directs blood flow toward the growing brain in fetuses with CHD. We hypothesized that these changes would result in impaired fetal kidney growth.
Methods:
The preoperative ultrasound measurements of kidney length were obtained retrospectively from 452 neonates requiring surgery for CHD. Percentiles were generated based on regression analysis of normative kidney length from three datasets according to both corrected gestational age and to birthweight.
Results:
As a cohort, neonates with CHD have significantly enlarged kidneys, with a mean percentile ranging from 54.1-72.7 (p < 0.001), depending on the three normal population datasets used for comparison. The kidneys of neonates with left heart obstruction were consistently demonstrated to be greater than normal, unlike those with cyanotic heart disease which were shown to have either normal or enlarged kidneys, depending on the reference population used.
Conclusions:
The kidneys of newborns with CHD are not reduced in size, and on average are larger than normal. The nature of this size discrepancy and its subsequent clinical significance is unknown.
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