Prediction of risk factors and clinical features of asphyxia-related neonatal acute kidney injury

Objective To investigate the risk factors and clinical characteristics of asphyxia-related acute kidney injury (AKI) in neonates.

Methods A retrospective analysis was conducted on the clinical data of neonates with asphyxia-related AKI (AKI group, n=100) and asphyxia withont AKI neonates (control group, n=228) admitted to the neonatal intensive care unit (NICU) of the First Affiliated Hospital of Nanjing Medical University from January 2020 to December 2023. Laboratory indicators and clinical data from both groups were collected to analyze the risk factors and clinical characteristics of asphyxia-related AKI in neonates.

Results Statistically significant differences were observed in levels of lactate, base excess (BE), serum potassium, serum creatinine, and urea nitrogen between the AKI and control groups (P < 0.05). Multivariate Logistic regression analysis revealed that low 5-minute Apgar score, high lactate level, and hyperglycemia were independent risk factors for asphyxia-related AKI in neonates. The areas under the curve (AUCs) for the 5-minute Apgar score, lactate, and blood glucose in predicting AKI were 0.825(95%CI, 0.767 to 0.882), 0.968(95%CI, 0.942 to 0.993), and 0.845(95%CI, 0.795 to 0.894), respectively. The incidence of maternal hypertension during pregnancy also showed a significant difference between the two groups (P < 0.05). Significant differences were also noted in 1-minute and 5-minute Apgar scores, as well as the incidence of intrauterine distress between the AKI and control groups (P < 0.05). Furthermore, the AKI group exhibited statistically significant differences in respiratory distress syndrome (RDS), respiratory failure, necrotizing enterocolitis (NEC), severe intracranial hemorrhage, pulmonary hemorrhage, use of diuretics, and blood purification etc. compared to the control group (P < 0.05). There were 24 deaths in the AKI group, with 16 cases in AKI stage 3 and 8 cases in AKI stage 2, while only 3 deaths occurred in the control group. The difference in mortality rate between the two groups was statistically significant (P < 0.05).

Conclusion Low 5-minute Apgar score, high lactate levels, and hyperglycemia are independent risk factors for AKI in neonates. Neonates with AKI are prone to developing multi-organ dysfunction, and asphyxia-related AKI can increase mortality rates. Therefore, comprehensive prevention and treatment measures are crucial.