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Decreased renal function among children born to women with obstructed labour in Eastern Uganda: a cohort study
David Mukunya1,2, Faith Oguttu3, Brendah Nambozo1
1Department of Community and Public Health, Busitema University, Mbale, Uganda.
Insights
Children born after obstructed labor show high rates of reduced kidney function. Early monitoring of renal function is crucial for these high-risk infants to prevent chronic kidney disease.
Area of Science:
- Pediatrics
- Nephrology
- Public Health
Background:
- Chronic kidney disease affects millions globally, with early life insults potentially increasing risk.
- Obstructed labor is a significant obstetric complication, particularly in low-resource settings.
- Investigating the long-term renal health of children born following such events is critical.
Purpose of the Study:
- To assess the renal function of young children (aged 2-4 years) born to mothers who experienced obstructed labor.
- To determine the incidence of reduced kidney function in this vulnerable pediatric population.
Main Methods:
- A cohort of 144 children born to women with obstructed labor in Eastern Uganda was followed.
- Serum creatinine levels were measured to calculate estimated glomerular filtration rate (eGFR) using the Schwartz formula.
- Reduced renal function was defined as an eGFR below 90 ml/min/1.73m².
Main Results:
- The mean eGFR among the children was 85.8 ± 15.9 ml/min/1.73m², with a wide range (55-163 ml/min/1.73m²).
- A significant majority (68.8%) of children exhibited reduced renal function (eGFR < 90 ml/min/1.73m²).
- Two-thirds of the children had mild decreases in eGFR (60-89 ml/min/1.73m²).
Conclusions:
- There is a high incidence of reduced renal function in children born following obstructed labor.
- Routine renal function monitoring is recommended for infants born to mothers with obstructed labor.
- Improved intra-partum and peripartum care is essential to mitigate risks associated with obstructed labor.
Background:
Over two million children and adolescents suffer from chronic kidney disease globally. Early childhood insults such as birth asphyxia could be risk factors for chronic kidney disease in later life. Our study aimed to assess renal function among children aged two to four years, born to women with obstructed labour.
Methods:
We followed up 144 children aged two to four years, born to women with obstructed labor at Mbale regional referral hospital in Eastern Uganda. We used serum creatinine to calculate estimated glomerular filtration rate (eGFR) using the Schwartz formula. We defined decreased renal function as eGFR less than 90 ml/min/1.73m2.
Results:
The mean age of the children was 2.8 years, standard deviation (SD) of 0.4 years. Majority of the children were male (96/144: 66.7%). The mean umbilical lactate level at birth among the study participants was 8.9 mmol/L with a standard deviation (SD) of 5.0. eGFR of the children ranged from 55 to 163 ml/min/1.73m2, mean 85.8 ± SD 15.9. Nearly one third of the children (45/144) had normal eGFR (> 90 ml/Min/1.73m2), two thirds (97/144) had a mild decrease of eGFR (60-89 ml/Min/1.73m2), and only two children had a moderate decrease of eGFR (< 60 ml/Min/1.73m2). Overall incidence of reduced eGFR was 68.8% [(99/144): 95% CI (60.6 to 75.9)].
Conclusion:
We observed a high incidence of reduced renal function among children born to women with obstructed labour. We recommend routine follow up of children born to women with obstructed labour and add our voices to those calling for improved intra-partum and peripartum care.
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