Prevalence of Acute Kidney Injury among Asphyxiated Term Neonates Admitted to Mulago National Referral Hospital, Uganda; A Cross-sectional Study

Abstract

Background: Acute Kidney Injury is a recognized complication of birth asphyxia, carrying a poor prognosis and may lead to permanent renal damage in up to 40% of those who survive. Asphyxia affects almost all organs in the body. This study aimed to determine the prevalence and factors associated with acute kidney injury among asphyxiated neonates admitted to the special care unit of Mulago Hospital.

 Methods: This was a cross-sectional study on term asphyxiated neonates admitted within 24 hours of delivery to a special care unit, carried out between March and July 2016.  Serum creatinine was measured on day 3 of life and acute kidney injury was defined as serum creatinine ≥ 133µmol/l. Outcome information was extracted from the patient records on day 7 of admission. Data was entered using Epi data 3.1 and analyzed using STATA version12.0 software.

Results:  A total of 194 neonates were recruited; their median age was 39 weeks (IQR 38, 40), and 68% were male. Of these, 18/194 (9.3%; 95% CI 5.56, 14.26) had AKI. Of those with AKI, 44.4% had stage I Hypoxic ischemic encephalopathy (HIE), 44.4% stage II HIE and 11.1% stage III HIE. Inadequate fluids/feeds intake in the first 72 hours of life was independently associated with AKI, (OR 10.6; 95% CI 2.39, 47.08). Six (33 %) of the 18 patients who developed AKI died by day 7, all of whom had either HIE stage II or stage III.

 Conclusion: One in ten asphyxiated neonates in this study had AKI, indicating a common problem. The AKI was associated with inadequate fluids/feeds in the first 72 hours of life.