Perinatology.  2024 Dec;35(4):134-139. 10.14734/PN.2024.35.4.134.

Acute Kidney Injury in Neonates with Hypoxic-Ischemic Encephalopathy Under going Therapeutic Hypothermia

• Yang EM
• Song ES

• KMID: 2563891
• DOI: http://doi.org/10.14734/PN.2024.35.4.134

Abstract

Objective
Hypoxic-ischemic encephalopathy (HIE) frequently leads to neurological complications, such as seizures and developmental disorders. In addition to these challenges, many infants with HIE experience multi-organ dysfunction, and HIE is a major cause of acute kidney injury (AKI) during the neonatal period. This study aimed to investigate the risk factors for AKI in neonates treated with therapeutic hypothermia (TH) for HIE.
Methods
We retrospectively reviewed neonates who received TH for HIE at a single center between January 2015 and August 2024. AKI was defined according to the neonatal modified Kidney Disease Improving Global Outcome criteria. Initial blood gas analysis, seizures, severity of HIE, neurologic studies, and mortality were compared between infants with and without AKI.
Results
Among 288 neonates with HIE, TH was performed on 60 neonates, of which 3 were ex cluded, resulting in a total of 57 neonates. A total of 25 patients (43.9%) developed AKI, of whom 10 had stage 1 AKI, 6 had stage 2 AKI, and 9 had stage 3 AKI. In stage 3 AKI, one patient (1.8%) needed renal replacement therapy. Initial pH (P=0.040) and base excess (BE) (P=0.008) were significantly lower in the AKI group compared to the non-AKI group. AKI patients had a significantly higher rate of severe HIE (P=0.018), convulsions (P=0.022), and mortality (P=0.017). In logistic regression analysis, low initial BE and the presence of convulsion were independently associated with an increased risk of AKI, with odds ratios of 1.16 and 3.95, respectively.
Conclusion
AKI remains common in neonates with HIE treated with TH. Low BE and convulsion were identified as independent risk factors for the development of AKI.

Keyword

Acute kidney injury; Hypoxic-ischemic encephalopathy; Therapeutic hypothermia