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Glomerular filtration rate in the preterm infant: the relation to gestational and postnatal age
A J van der Heijden1, W F Grose, J J Ambagtsheer
1Department of Paediatric Nephrology, Erasmus University, Rotterdam, The Netherlands.
Insights
Glomerular filtration rate (GFR) in preterm neonates increases with gestational age and body weight. A further postnatal rise in GFR occurs, independent of body weight, suggesting renal hemodynamic changes.
Area of Science:
- Neonatal Physiology
- Renal Function in Preterm Infants
Background:
- Preterm neonates exhibit immature renal function.
- Understanding glomerular filtration rate (GFR) development is crucial for preterm infant care.
Purpose of the Study:
- To measure GFR in preterm neonates using a reliable technique.
- To investigate the factors influencing GFR during postnatal development.
Main Methods:
- Continuous inulin infusion technique used in 41 preterm neonates (27-36 weeks gestational age).
- GFR measurements correlated with gestational age, body weight, and postnatal day.
Main Results:
- GFR increased with advancing gestational age and body weight (r=0.48, P=0.0048).
- A significant postnatal increase in GFR (ml/min.kg) was observed between day 4 and day 11 (P<0.008).
- Artificial ventilation did not significantly affect GFR in this cohort.
Conclusions:
- Neonatal GFR development is influenced by both gestational age and postnatal maturation.
- Postnatal GFR increase may be linked to evolving renal hemodynamics.
- The continuous inulin infusion technique is reliable for assessing GFR in preterm infants.
Abstract:
In 41 preterm neonates with a gestational age (GA) varying from 27 to 36 weeks, glomerular filtration rate (GFR) was measured by means of the continuous inulin infusion technique. The reliability of the technique was confirmed. During postnatal development GFR was found to increase in two ways: firstly, an increase with advancing gestational age, associated with the increase in body weight (BW) [GFR (ml/min) = 0.15 X GA-3.20, r = 0.48, P = 0.0048]; secondly, a postnatal increase, being independent from increment in BW. An increase in GFR (ml/min.kg) from 0.88 +/- 0.23 to 1.18 +/- 0.28 was observed between day 4 and day 11 postnatally (P less than 0.008). This latter increase is probably associated with changes in renal haemodynamics. No significant influence of artificial ventilation on GFR could be demonstrated in preterm neonates.