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Association of intrauterine growth restriction and low birth weight with acute kidney injury in preterm neonates

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Abstract  

Background

Preterm birth alters nephrogenesis and reduces the total nephron number. Intrauterine growth restriction (IUGR) seems to worsen nephron loss, but only a few studies have investigated its role in neonatal kidney impairment. We investigated whether IUGR, defined as reduced estimated fetal growth and/or placental flow alterations and low birth weight z-score, increases the risk of developing acute kidney injury (AKI) in very preterm infants.

Methods

We performed a retrospective study including infants born with a birth weight (BW) ≤ 1500 g and/or gestational age (GA) ≤ 32 weeks admitted to our center between January 2016 and December 2021. Neonatal AKI was defined according to the neonatal KDIGO classification based on the decline of urine output and/or creatinine elevation. We used multivariable linear regressions to verify the association between AKI and GA, BW z-score, IUGR definition, and hemodynamically significant patent ductus arteriosus (PDA).

Results

We included 282 infants in the analysis, with a median (IQR) GA = 29.4 (27.4, 31.3) weeks, BW = 1150 (870, 1360) g, and BW z-score =  − 0.57 (− 1.64, 0.25). AKI was diagnosed in 36 (13%) patients, and 58 (21%) had PDA. AKI was significantly associated with BW z-score (beta (std. error) =  − 0.08 (0.03), p = 0.008) and severe IUGR (beta (std. error) = 0.21 (0.08), p = 0.009), after adjusting for GA and PDA.

Conclusions

Our data suggest that low BW z-score and IUGR could represent adjunctive risk factors for kidney impairment in preterm babies.

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Authors and Affiliations

  1. Neonatal Intensive Care Unit, Fondazione IRCCS San Gerardo Dei Tintori, Via Pergolesi 33, 20900, Monza, Italy

    Mariateresa Sinelli, Emanuela Zannin, Daniela Doni & Maria Luisa Ventura

  2. Unit of Obstetrics, Fondazione IRCCS San Gerardo Dei Tintori, Monza, Italy

    Sara Ornaghi, Eleonora Acampora, Nadia Roncaglia & Patrizia Vergani

  3. Bicocca School of Medicine and Surgery, University of Milan, Monza, Italy

    Sara Ornaghi & Patrizia Vergani

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  1. Mariateresa Sinelli
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  2. Emanuela Zannin
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Sinelli, M., Zannin, E., Doni, D. et al. Association of intrauterine growth restriction and low birth weight with acute kidney injury in preterm neonates. Pediatr Nephrol 38, 3139–3144 (2023). https://doi.org/10.1007/s00467-023-05936-8

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  • DOI: https://doi.org/10.1007/s00467-023-05936-8

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