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Prognostic role of acute kidney injury on long-term outcome in infants with hypoxic-ischemic encephalopathy

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Abstract

Background

The objective of this study was to evaluate the prognostic role of postnatal acute kidney injury (AKI) on neurodevelopmental outcome in infants with hypoxic-ischemic encephalopathy (HIE) receiving therapeutic hypothermia (TH).

Methods

This is a prospective observational study including all neonates with HIE receiving TH between 2009 and 2016 at a single center. AKI was classified according to the Kidney Disease: Improving Global Outcomes definition modified for neonatal age. Child development was assessed using the Griffiths Mental Development Scales (GMDS). Study outcome was defined as unfavorable outcome (including death or disability according to GMDS) or favorable otherwise, at 12 and 24 months.

Results

One-hundred and one neonates (median gestational age 39 weeks) were included. AKI was diagnosed in 10 neonates (10%). Seven patients died within the first year, 35 patients had disability at 12 months, and 45 patients at 24 months. AKI was associated with increased likelihood of unfavorable outcome at 24 months (100% vs. 59% in neonates without AKI; p = 0.01). AKI showed good positive predictive value (1.00, 95% CI 0.71–1.00) and specificity (1.00, 95% CI 0.88–1.00), but poor negative predictive value (0.41, 95% CI 0.30–0.52) and sensitivity (0.19, 95% CI 0.11–0.32) at 24 months.

Conclusions

AKI might be a reliable indicator of death or long-term disability in infants with HIE receiving TH, but the absence of AKI does not guarantee a favorable long-term outcome.

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Acknowledgments

We are grateful to the parents of babies enrolled in the study. We thank the medical staff and nurses for their support.

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Authors and Affiliations

  1. Independent statistician, Solagna, Italy

    Francesco Cavallin

  2. Department of Woman’s and Child’s Health, University of Padova, Via Giustiniani, 3, 35128, Padua, Italy

    Giulia Rubin, Luca Bonadies, Agnese Suppiej & Daniele Trevisanuto

  3. Division of Pediatrics, Department of Medicine, University of Udine, Udine, Italy

    Enrico Vidal

  4. Department of Developmental and Social Psychology, University ofPadova, Padua, Italy

    Elisa Cainelli

  5. Department of Medical Sciences-Pediatric Section, University ofFerrara, Ferrara, Italy

    Agnese Suppiej

Authors
  1. Francesco Cavallin
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  2. Giulia Rubin
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  3. Enrico Vidal
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  4. Elisa Cainelli
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  5. Luca Bonadies
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  6. Agnese Suppiej
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  7. Daniele Trevisanuto
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Corresponding author

Correspondence to Daniele Trevisanuto.

Ethics declarations

This study was performed as part of a project on perinatal asphyxia approved by the Ethics Committee of the Azienda Ospedaliera di Padova in Padua, Italy (number 67575 RF-2009-1511075) and written informed consent was obtained from the parents.

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The authors declare that they have no conflicts of interest.

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Cavallin, F., Rubin, G., Vidal, E. et al. Prognostic role of acute kidney injury on long-term outcome in infants with hypoxic-ischemic encephalopathy. Pediatr Nephrol 35, 477–483 (2020). https://doi.org/10.1007/s00467-019-04406-4

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  • DOI: https://doi.org/10.1007/s00467-019-04406-4

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