Non-invasive continuous renal tissue oxygenation monitoring to identify preterm neonates at risk for acute kidney injury,Pediatric Nephrology

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Non-invasive continuous renal tissue oxygenation monitoring to identify preterm neonates at risk for acute kidney injury
Pediatric Nephrology ( IF 2.6 ) Pub Date : 2021-01-03 , DOI: 10.1007/s00467-020-04855-2
Matthew W Harer _{1,

2} , Claudette O Adegboro _{1,

2} , Luke J Richard ₁ , Ryan M McAdams _{1,

2}

Affiliation

Background

Near-infrared spectroscopy (NIRS) is an emerging tool to identify signs of inadequate tissue oxygenation in preterm neonates with acute kidney injury (AKI). Previous studies have shown a correlation between low renal tissue oxygenation (RrSO₂) in the first 24 hours of age and the later development of AKI. In this prospective clinical trial, NIRS monitoring was used to identify changes in RrSO₂ in comparison to traditional AKI markers, serum creatinine (SCr), and urine output (UOP).

Methods

We enrolled 35 preterm neonates born less than 32 weeks’ gestation and applied neonatal NIRS sensors at less than 48 hours of age. Neonates underwent 7 days of continuous monitoring. Renal and demographic information were collected for the first 7 days of age. AKI was determined by the modified neonatal Kidney Disease: Improving Global Outcomes (KDIGO) definition including UOP.

Results

Three patients experienced AKI, all based on both SCr and UOP criteria. Each neonate with AKI had decreases in RrSO₂ over 48 hours prior to changes in SCr and UOP. Patients with AKI had lower median RrSO₂ values compared to patients without AKI over the first week of age, (32.4% vs. 60%, p < 0.001).

Conclusion

RrSO₂ monitoring identified preterm neonates at risk for AKI. NIRS detected a decline in RrSO₂ prior to changes in SCr and UOP and was significantly lower in patients with AKI compared to those without AKI. Further studies are needed to evaluate the ability of RrSO₂ monitoring to detect signs of kidney stress prior to the diagnosis of AKI.

中文翻译：

无创连续肾组织氧合监测以识别有急性肾损伤风险的早产儿

背景

近红外光谱 (NIRS) 是一种新兴工具，用于识别患有急性肾损伤 (AKI) 的早产新生儿组织氧合不足的迹象。先前的研究表明，最初 24 小时的低肾组织氧合 (RrSO ₂ ) 与 AKI 的后期发展之间存在相关性。在这项前瞻性临床试验中，NIRS 监测用于识别 RrSO ₂与传统 AKI 标志物、血清肌酐 (SCr) 和尿量 (UOP) 相比的变化。