Hipoksično oštećenje bubrega u donešene novorođenčadi kao pokazatelj njihova neurološkog ishoda [Hypoxic renal injury in term newborns as an indicator of neurologicaloutcome]

Background: Early prediction of neurological outcome after neonatal asphyxia is important for ensuring right medical decisions. Numerous studies investigated the usefulness of some biochemical markers in serum, urine or cerebrospinal fluid in predicting neurological outcome after perinatal asphyxia. Since kidney is, after brain, the second most often affected organ after perinatal asphyxia, we hypotesised that an acute postasphyxial renal injury in term newborn could indicate a neurological outcome. ----- Methods: We conducted a prospective clinical trial on 50 full-term newborns with 5-minute Apgar score < 7 and a control group of 50 full-term newborns with 5- minute Apgar score ≥ 7. Renal function was assessed on the third day of life by serum values of creatinine, cystatin C and β2-microglobulin (β2M) and glomerular filtration rate (GFR). All newborns had renal and brain ultrasonography at early stages and were followed by Amiel-Tison Neurological Assessment (ATNA) throughout the first year of life. ----- Results: Mean GFR was significantly lower in asphyxiated than in nonasphyxiated group (22,08 ± 6,66 ml/min/1,73m² vs. 35,42 ± 2,26 ml/min/1,73m²; P<0,001) and serum values of creatinine, cystatin C and β2M were significantly higher (1,13 vs.0,66 mg/dl; 3,92 vs.1,52 mg/l; 1,53 vs.0,99mg/l ; P<0,001). In asphyxiated group ATNA results throughout the first year of life significantly correlated with renal function (P<0,01). A correlation of ATNA with Apgar score at 5 minutes, Sarnat and Sarnat staging of hypoxic ischemic encephalopathy and brain and renal ultrasonography has also been significant (P<0,01). ----- Conclusions: Our study showed a significant correlation between early impairment of renal function due to neonatal asphyxia with neurological outcome at the end of the first year of life. We can conclude that measuring of renal function parameters at early stages after perinatal asphyxia can, complementary to other methods, be useful in prediction of neurological outcome after perinatal asphyxia.