Renal Regional Oxygen Saturation (rSrO2) and Acute Kidney Injury in neonates with perinatal asphyxia.

ABSTRACT

OBJECTIVE: Neonates with moderate-to-severe perinatal asphyxia often develop Acute Kidney Injury (AKI). Additionally, therapeutic hypothermia can affect renal blood flow. This study aimed to evaluate the association between renal regional oxygen saturation (rSrO2) during therapeutic hypothermia and AKI in neonates with moderate and severe perinatal asphyxia. STUDY DESIGN: This retrospective longitudinal study included neonates with moderate-to-severe asphyxia who required therapeutic hypothermia. The primary outcome was the occurrence of Acute Kidney Injury (AKI), classified as a rate of decrease in creatinine levels of < 33% at 72 h of therapeutic hypothermia. Renal regional oxygen saturation (rSrO2) was continuously monitored by Near-Infrared Spectroscopy during the hypothermia and rewarming phases. Data analysis involved dividing the average rSrO2 levels into 12-hour periods. We analyzed the association between AKI and rSrO2 levels using univariate and multivariate logistic regression models. Furthermore, we assessed the predictive capacity of rSrO2 for AKI by analyzing the area under the ROC curve. RESULTS: Ninety-one patients were included in the study. On an average, patients with AKI exhibit lower rSrO2 levels during therapeutic hypothermia. Specifically, rSrO2 levels within the first 12 h and between 25 and 72 h of therapeutic hypothermia demonstrated the highest predictive capability for AKI. Multivariate logistic regression analysis revealed that rSrO2 levels within the initial 12 h (adjusted odds ratio [aOR] 1.11, 95% CI 1.01 - 1.21) and between 61 and 72 h (aOR 0.85, 95% CI 0.78 - 0.92) were significantly associated with AKI.