Initial lactate levels linked to oliguria in term neonates with perinatal asphyxia.

BACKGROUND: Oliguria is a sign of impaired kidney function and has been shown to be an early predictor of adverse prognoses in patients with acute kidney injury. The relationship between urine output (UOP) and early lactate levels in neonates with perinatal asphyxia (PA) has not been extensively explored. This study aimed to investigate the link between oliguria during the first 24 h of life and early lactate levels in neonates with PA. METHODS: The medical records of 293 term neonates with asphyxia from 9216 hospitalized newborns were retrospectively analyzed, including 127 cases designated as the oliguria group and 166 cases as controls. Peripheral arterial blood gas after PA and UOP within 24 h after birth were analyzed. Logistic regression analyses and receiver operating characteristic curve analysis were conducted. RESULTS: Oliguria occurred in 43.34% of neonates with PA. The median UOP of the oliguria and control groups were 0.65 and 1.46 mL/kg/h, respectively. Elevated lactate levels after PA are an independent risk factor for oliguria in the following 24 h (p = 0.01; OR: 1.19; 95%CI: 1.04-1.35) and show a moderate discriminatory power for oliguria (AUC = 0.62). Using a cut off value of 8.15 mmol/L, the positive and negative predictive values and the specificity were 59.34%, 63.86%, and 78.30%, respectively. CONCLUSION: Neonates with elevated lactate levels after PA face a risk of oliguria in the following 24 h. Based on early elevated lactate levels after resuscitation, especially ≥ 8.15 mmol/L, meticulously monitoring UOP will allow this vulnerable population to receive early, tailored fluid management and medical intervention.

Urine neutrophil gelatinase-associated lipocalin in asphyxiated neonates: a prospective cohort study.

BACKGROUND: Acute kidney injury (AKI) is the most common complication of perinatal asphyxia. Recent research indicates that urine neutrophil gelatinase-associated lipocalin (NGAL) is an early marker for AKI; yet, there is a paucity of data about its use in term neonates with perinatal asphyxia. METHODS: A prospective cohort study was conducted on 108 term babies in the new-born unit of Pumwani Maternity Hospital and Kenyatta National Hospital. Urine NGAL and serum creatinine were measured in 108 term asphyxiated neonates on days 1 and 3 of life. RESULTS: One-hundred and eight patients were recruited (male:female 1.4:1). At a cut-off of 250 ng/ml, urine NGAL had an acceptable discriminative capability of predicting AKI (area under the curve 0.724). The sensitivity, specificity, positive and negative predictive value and likelihood ratios were 88, 56, 30, 95%, 2 and 0.2 respectively. Urine NGAL levels were significantly higher in patients with AKI compared with those without AKI. An NGAL level greater than 250 ng/ml on day 1 was significantly associated with severe hypoxic ischaemic encephalopathy (HIE); odds ratio = 8.9 (95% CI 1.78-37.69) and mortality; odds ratio = 8.9 (95% CI 1.78-37.69). CONCLUSION: Urine NGAL is a good screening test for the early diagnosis of AKI. It is also a predictor of mortality and severity of HIE in asphyxiated neonates.

Urinary NGAL to define AKI in asphyxiated infants.

Acute kidney injury (AKI) is independently associated with poor outcomes in the critically ill patient. The standard kidney function biomarker, serum creatinine, shows a demonstrable rise in concentration many hours to days after insult to the kidney. Thus, creatinine-based AKI diagnosis is likely delayed, rendering treatments to mitigate or prevent AKI ineffective. Neonatal AKI is further confounded by the fact that infant serum creatinine concentrations reflect maternal levels. The past 15 years has seen a massive research effort to identify early damage markers of AKI, with the hope that earlier "sub-clinical" AKI diagnosis can lead to earlier initiation of AKI treatment, or to adjustment of care to mitigate the adverse effects of AKI until renal function recovery occurs. One of the most promising urinary AKI biomarkers, neutrophil gelatinase associated lipocalin (NGAL), has repeatedly performed well to predict AKI in many pediatric populations, including those post-cardiac surgery, critically ill mechanically ventilated children and children arriving to the emergency department. The study reported by Admani et al. uses NGAL not only to predict serum creatinine-based AKI, but also to define AKI to associate a Day 1 NGAL concentration above a specific threshold with clinical outcomes.

Serum and urine acute kidney injury biomarkers in asphyxiated neonates.

BACKGROUND: We evaluated serum (s) cystatin C (CysC) and neutrophil gelatinase-associated lipocalin (NGAL) and urine (u) CysC, NGAL and kidney injury molecule-1 (KIM-1) as markers of acute kidney injury (AKI) in asphyxiated neonates. METHODS: AKI biomarkers were measured in 13 asphyxiated neonates born at ≥ 36 weeks gestational age (eight with AKI and five without AKI) and 22 controls. AKI was defined as serum creatinine ≥ 1.5 mg/dl for >24 h or rising values >0.3 mg/dl from day of life (DOL) 1. Biomarkers were measured on DOL 1, 3, and 10. RESULTS: Asphyxiated neonates had significantly higher sCysC on DOL 1 as well as sNGAL and uCysC and uNGAL (standardized to urine creatinine and absolute values) than controls at all time points. Compared to controls, significantly higher sNGAL, uCysC, and uNGAL values were observed in the asphyxia-AKI and asphyxia-no AKI subgroups. Regarding uKIM-1, only the absolute values were significantly higher in asphyxiated neonates (DOL 10). sNGAL, uCyst, and uNGAL had a significant diagnostic performance as predictors AKI on DOL 1. CONCLUSIONS: sNGAL, uCysC, and uNGAL are sensitive, early AKI biomarkers, increasing significantly in asphyxiated neonates even in those not fulfilling AKI criteria. Their measurement on DOL 1 is predictive of post-asphyxia-AKI.

[Change in the level of inflammatory cytokines and their relationship to the indicator in evaluating renal tubules injury of urinary in neonates with asphyxia].

OBJECTIVE: To explore the relationship between amount of inflammatory cytokines in urine and neonatal postasphyxia renal tubules injury. METHODS: The level of inflammatory cytokines such as interleukin (IL-8, IL-6), tumor necrosis factor-alpha (TNF-alpha) and the indicators of evaluating renal tubules injury [N-acetyl-glucosaminidase(NAG), gamma-glutamyltranspeptidase (gamma-GT), beta(2)-microglobulin (beta(2)-MG)] in urine were detected in neonates with asphyxia. RESULTS: Compared with control, the levels of IL-8, IL-6, TNF-alpha and NAG, gamma-GT, beta2-MG were obviously increased in mild asphyxia group. In severe asphyxia group, the parameters above were all significantly increased compared with mild asphyxia group and the control group. Within the asphyxia group, there were positive relationship between inflammatory cytokines and the indicator of evaluating renal tubules injury. CONCLUSION: The asphyxia may induce systemic inflammatory response syndrome (SIRS), which result in postasphyxia renal injury in neonates. The level of inflammatory cytokines in urine may be used as the indicators of evaluating the severity of asphyxia and postasphyxia renal injury in neonates.

[Novel renal function marker, ATP--establishing the normal range, cases of anti-tumor drags administration for urinary-track tumor, diabetic diseases and a newborn baby].

Urinary free ATP assay by the firefly luciferin-luciferase method is a rapid and simple method for determining renal function, especially uriniferous tubule function. Normal range of urinary free ATP concentration, daily ATP excretion in urine, urinary ATP/creatinine value and ATP decomposition activity in urine is 1.1 x 10(-9)-3.4 x 10(-8) M, 4.0 x 10(-9)-4.1 x 10(-8) mole, 5.0 x 10(-13)-5.9 x 10(-11) mol/mgCr and 100-77% express for the remaining rate of additional ATP, respectively. A significant correlation was found between free ATP concentration and daily ATP excretion in urine with a correlation coefficient of 0.84. In cases of anti-tumor drug(cisplatin = cis-diamminedichloroplatinum II) administration for urinary-track tumor, abnormal urinary free ATP concentration and ATP decomposition activity in urine were clearly demonstrated after a few days of cisplatin administration. The appearance of a tendency toward abnormal relative ATP values were similar to changes in beta 2-MG and NAG values. Diabetic patients often demonstrate unusually high values of urinary free ATP concentration. In asphyxia of the newborn, urinary ATP/creatinine value were significantly higher than those in healthy newborn, but urinary NAG values did not differ.

Urinary excretion of free cysteine in critically ill neonates.

UNLABELLED: In preliminary observations, significant amounts of free cysteine, a neurotoxic amino acid, were noted in the urine of asphyxiated or septic-shocked neonates. The present study was conducted to determine whether free urinary cysteine was elevated in these critically ill neonates compared with a control group, and to assess the clinical significance of this generation. Free cysteine was measured in the urine of newborn infants with perinatal asphyxia (n = 16) or neonatal sepsis (n = 14) and the urine of a control group (n = 10) by ion-exchange chromatography. Relationships between cysteine levels and the clinical severity, sulfite supply and neurological outcome of the patients were then studied. Urinary cysteine was 27.6 (15-49) mmol mol(-1) creatinine for the patients but was not detectable in the control group. Cysteine levels were correlated with the severity of neonatal septic shock but not with the grade of perinatal asphyxia and did not have a specific influence on the neurological outcome of these patients. The correlation between cysteine level and the severity of neonatal septic shock was indirect and probably linked to higher sulfite administration in this population. CONCLUSION: The mean daily supply of sulfites is high in critically ill neonates, mainly originating from dopamine and generating significant amounts of cysteine. Although a worsening effect attributable to cysteine on the neurological outcome of the patients could not be demonstrated, the appropriateness of cryptic administration of sulfites by way of drug excipients is called into question.

Measurement and clinical significance of endothelin in neonatal urine.

The present study was undertaken to figure out the source of urinary endothelin (ET) and the clinical significance of its possible variations. Urinary ET levels were measured by radioimmunoassay (RIA) in 17 healthy newborns and 20 asphyxiated neonates on days 1, 3, 7 after birth. Plasma ET concentrations of healthy premature infants on day 7 and urinary ET levels in 10 healthy children were also observed at the same time. Results showed that: (1) Urinary ET levels and ET excretion rates were higher than plasma ET in preterm infants on days 7 after birth; (2) Both in preterm and full term infants, urinary ET concentrations fell from the 1st day to the 7th day after birth, ET excretion rates elevated markedly at the end of the 1st week, and they were significantly higher than that of children; (3) Urinary ET levels of asphyxiated group on days 1 and 3 were much higher than those of healthy neonates, and positively correlated with the severity of the illness and urinary NAG. We conclude that: (1) urinary ET mainly comes from the production in renal cells; (2) ET levels in healthy neonatal urine reflect the maturity of kidney; (3) measurement of urinary ET levels in asphyxiated neonates is helpful to judge the degree and to evaluate the prognosis of renal injury.

[Urinary N-acetyl-beta-D-glucosaminidase activity in healthy, polycythemic and hypoxic newborn infants]. / Vizelet N-acetyl-beta-D-glucosaminidase aktivitás egészséges, polycythaemiás és hypoxiás újszülöttekben.

Urinary N-acetyl-beta-D-glucosaminidase (NAG) activity was assayed in 20 polycythemic newborns and prematures, together with 50 prematures suffering from hypoxia on the 1st, 2nd, 4th, 14th, and 28th day after birth. The enzyme was also assayed in 101 healthy newborns which provided normal reference values. NAG activity was factored by the creatinine concentration to given an index. There were significant difference in the NAG indices either between full-term and preterm babies or between appropriate for gestational age (AGA) and small for gestational age (SGA) neonates of the normal group. However, NAG excretion on the first day of life was significantly raised in the case of polycythemic newborns. Following partial plasma exchange, on the 14th day the NAG activity returned to the normal range. NAG activities of premature babies suffering from idiopathic respiratory distress syndrome (IRDS) were significantly elevated on the 1st, 2nd, 4th day but fell sharply to the 14th day. NAG activity fell to normal values by the 28th day. These results suggest that the urinary NAG index is a sensitive indicator of the renal tubular damage during the newborn period.