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Published on: October 28, 2022
Renal artery flow alterations in neonates with hypoxic ischemic encephalopathy
Banu Aydın1, Nurullah Okumuş2, Mehmet Burak Özkan3
1Neonatology Unit, Department of Pediatrics, Faculty of Medicine, Lokman Hekim University, Söğütözü Mh. 2179 Cd. No: 6, Ankara, Turkey. b_ay_yz@yahoo.com.
Insights
Therapeutic hypothermia (TH) improved kidney blood flow and function in infants with hypoxic ischemic encephalopathy (HIE). These findings suggest TH aids renal recovery during the neonatal period.
Area of Science:
- Neonatal Medicine
- Pediatric Nephrology
- Critical Care Pediatrics
Background:
- Hypoxic ischemic encephalopathy (HIE) poses risks to neonatal kidney function.
- Therapeutic hypothermia (TH) is a standard treatment for HIE.
- The impact of TH on neonatal kidney blood flow and function requires further investigation.
Purpose of the Study:
- To compare kidney blood flow and function in infants with HIE.
- To evaluate the effects of TH on renal parameters in the first 7 days of life.
Main Methods:
- Prospective evaluation of 59 infants with HIE, categorized into moderate-severe HIE with TH (Group 1), mild HIE (Group 2), and healthy controls (Group 3).
- Kidney function tests (serum BUN, creatinine, uric acid, cystatin C, GFR) assessed at multiple time points.
- Renal artery Doppler ultrasonography (dUS) performed on days 1, 3, and 7.
Main Results:
- In Group 1, renal artery blood flow increased and resistive index decreased over time during TH (p<0.0001).
- Kidney function markers (BUN, creatinine, uric acid, cystatin C) improved, and GFR increased during TH in Group 1 (p<0.0001).
- Renal blood flow and function showed improvement in HIE infants treated with TH compared to controls.
Conclusions:
- Therapeutic hypothermia appears to promote the restoration of renal blood flow and kidney function in neonates with HIE.
- TH's neuroprotective effects may contribute to improved renal recovery during the neonatal adaptive period.
Background:
To compare kidney blood flow and kidney function tests in infants with hypoxic ischemic encephalopathy (HIE), and the effects of therapeutic hypothermia (TH) during the first 7 days of life.
Methods:
Fifty-nine infants with HIE were prospectively evaluated. Infants with moderate-severe HIE who required TH were classified as group 1 (n = 36), infants with mild HIE were classified as group 2 (n = 23), and healthy infants were classified as group 3 (n = 60). Kidney function tests were evaluated on the sixth hour, third and seventh days of life in Group 1 and Group 2, and on the sixth hour and third day of life in group 3. Renal artery (RA) Doppler ultrasonography (dUS) was performed in all infants on the first, third, and seventh days of life.
Results:
Systolic and end diastolic blood flow in RA tended to increase and RA resistive index (RI) tended to decrease with time in group 1 (p = 0.0001). While end diastolic blood flow rates in RA on the third day were similar in patients with severe HIE and mild HIE, it was lower in patients with mild-moderate-severe HIE than healthy newborns. On the seventh day, all three groups had similar values (p > 0.05). Serum blood urea nitrogen (BUN), creatinine, uric acid, and cystatin C levels gradually decreased and glomerular filtration rate (GFR) gradually increased during TH in group 1 (p = 0.0001). Serum creatinine levels gradually decreased while GFR gradually increased during the study period in group 2.
Conclusions:
Therapeutic hypothermia seems to help restore renal blood flow and kidney functions during the neonatal adaptive period with its neuroprotective properties.
