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Renal function in full-term neonates with hyperbilirubinemia
Y Haimi-Cohen1, P Merlob, M Davidovitz
1Nephrology Unit, Children's Medical Center of Israel, Israel.
Insights
Unconjugated hyperbilirubinemia in healthy newborns does not impair kidney function. This study found no significant differences in renal parameters between infants with and without jaundice, indicating no need for altered management.
Area of Science:
- Neonatology
- Pediatric Nephrology
- Biochemistry
Background:
- Neonatal hyperbilirubinemia is common in newborns.
- Concerns exist regarding its potential impact on immature renal function.
- Understanding renal effects is crucial for appropriate infant care.
Purpose of the Study:
- To evaluate the effect of unconjugated hyperbilirubinemia on kidney function in full-term infants.
- To assess endogenous creatinine clearance and urinary excretion of key substances.
- To determine if jaundice necessitates changes in managing renal function.
Main Methods:
- Studied 37 healthy, breast-fed, full-term newborns (3-5 days old).
- Compared 20 infants with hyperbilirubinemia (mean indirect bilirubin 16.4 mg/dl) to 17 controls (mean indirect bilirubin 7.8 mg/dl).
- Measured urine and serum creatinine, sodium, phosphorus, lysozyme, glucose, and amino acids; calculated creatinine clearance, fractional excretion of sodium (FENa), and tubular reabsorption of phosphate (TP/GFR).
Main Results:
- No statistically significant differences were observed in creatinine clearance between hyperbilirubinemic and control groups.
- Fractional excretion of sodium (FENa) and tubular reabsorption of phosphate (TP/GFR) also showed no significant variations.
- All measured renal function parameters remained comparable between the two groups.
Conclusions:
- Neonatal hyperbilirubinemia, with indirect bilirubin levels below 20.8 mg/dl, does not adversely affect the renal function of healthy, full-term newborns.
- Current management approaches for renal function in these infants do not require modification due to mild hyperbilirubinemia.
- This finding supports the safety of current practices for managing common neonatal jaundice.
Abstract:
The purpose of this study was to investigate the effect of unconjugated hyperbilirubinemia on endogenous creatinine clearance and urinary excretion of sodium, phosphorus, lysozyme, and amino acids in full-term infants. Thirty-seven healthy, breast-fed newborns who were not exposed to phototherapy were studied on their third to fifth day of life. Twenty had neonatal hyperbilirubinemia with a mean indirect bilirubin value of 16.4 mg/dl, whereas 17 who were used as controls had a mean indirect bilirubin value of 7.8 mg/dl. Urine was collected, and samples were taken for examination of creatinine, lysozyme, sodium, and phosphorus concentration. Urinary sediment, glucose, and amino acid levels were also measured. Serum total and direct bilirubin, creatinine, sodium, and phosphorus measurements were taken at the beginning of urine collection. Calculations were made for creatinine clearance, fractional excretion of sodium (FENa), and tubular reabsorption of renal phosphate per deciliter glomerular filtrate (TP/GFR). The means (+/-1 SD) of creatinine clearance, FENa, and TP/GFR were 27.0 +/- 14.2 ml/min/1.73 m2, 0.53% +/- 0.49%, and 5.72 +/- 1.16 mg/dl GF, respectively, in the hyperbilirubinemic group compared with 21.1 +/- 9.4 ml/min/1.73 m2, 0.4% +/- 0.47%, and 6.01 +/- 0.51 mg/dl GF, respectively, in the controls. No statistically significant differences were found between the groups for any of the examined parameters of either glomerular or tubular function. Neonatal hyperbilirubinemia < 20.8 mg/dl has no detrimental effect on renal function of healthy, breast-fed, full-term newborns, and no modification in the approach regarding renal function is necessary in these babies.