RENAL-FUNCTION IN PRETERM NEONATES
RENAL-FUNCTION IN PRETERM NEONATES
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DOI：
10.1203/00006450-199411000-00005
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发表时间：
1994-11-01
影响因子：
3.6
通讯作者：
GUIGNARD, JP
中科院分区：
文献类型：
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作者：
BUEVA, A;GUIGNARD, JP
血浆肌酐浓度在出生时升高，并随着出生后最初几周肾小球滤过率的迅速增加而降低。这些变化的速度在66个足月和早产儿出生后的前3周进行了评估。从出生后1-4天开始，以每周为间隔连续测量血浆肌酐浓度、肌酐清除率和钠分数排泄[平均= 1.5 +/- 0.8 (SD) d]。早产儿按出生体重分为三组：第1组，1001 ~ 1500克；第2组，1501 ~ 2000 g；第三组，2001到2500克。第4组包括28例足月儿（平均出生体重= 3165±78 g）。1、2、3组早产儿平均胎龄分别为31.3、32.8、34.4周。1.5 d时，早产儿血浆肌酐浓度（91 +/- 4 mu mol/L）显著高于足月儿（66 +/- 3 mu mol/L）。血浆肌酐在出生后第二周仍存在差异，1、2、3、4组分别为64 +/- 5、58 +/- 7、47 +/- 8、40 +/- 4 mu mol/L。差异在d 22-23时消失。1.5 d时，肌酐清除率与胎龄呈正相关，1、2、3、4组肌酐清除率分别为0.65 +/- 0.14、0.92 +/- 0.19、1.42 +/- 0.31、3.36 +/- 0.32 mL/min。肌酸酐清除率随着出生年龄的增加而迅速增加，成熟的速度在大多数早产儿中不太明显。大多数早产儿的钠排泄量显著增加，1、2、3和3组的钠排泄量分别为2.0 +/- 0.3、2.2 +/- 0.5、1.1 +/- 0.2和0.3 +/- 0.1%。这种差异在出生后的第三周就消失了。1.5 d时的血浆肌酐与胎龄呈负相关，提示新生儿的血浆肌酐浓度并不能简单地反映母亲的血浆浓度。
The plasma creatinine concentration is elevated at birth and decreases concomitantly with the rapid increase in glomerular filtration rate that occurs in the first postnatal weeks. The velocity of these changes was assessed during the first 3 wk of life of 66 term and preterm infants. The plasma creatinine concentration, creatinine clearance, and sodium fractional excretion were measured serially at weekly intervals, starting 1-4 d after birth [mean = 1.5 +/- 0.8 (SD) d]. Premature infants were separated into three groups according to their birth weight: group 1, 1001 to 1500 g; group 2, 1501 to 2000 g; and group 3, 2001 to 2500 g. Group 4 included 28 term infants (mean birth weight = 3165 +/- 78 g). Mean gestational ages in the preterm groups were 31.3, 32.8, and 34.4 wk in groups 1, 2, and 3, respectively. The plasma creatinine concentration on d 1.5 was significantly higher in preterm (91 +/- 4 mu mol/L) compared with term infants (66 +/- 3 mu mol/L). The differences in plasma creatinine were still present during the second week of life, with values of 64 +/- 5, 58 +/- 7, 47 +/- 8, and 40 +/- 4 mu mol/L in groups 1, 2, 3, and 4, respectively. The difference vanished by d 22-23. On d 1.5, creatinine clearance correlated positively with gestational age, amounting to 0.65 +/- 0.14, 0.92 +/- 0.19, 1.42 +/- 0.31, and 3.36 +/- 0.32 mL/min in groups 1, 2, 3, and 4, respectively. Creatinine clearance increased rapidly with postnatal age, the velocity of the maturation being less marked in the most premature infants. The fractional excretion of sodium was significantly higher in the most premature infants, with values of 2.0 +/- 0.3, 2.2 +/- 0.5, 1.1 +/- 0.2, and 0.3 +/- 0.1% in groups 1, 2, 3, and 3, respectively. The differences vanished by the third week of life. The negative correlation between plasma creatinine on d 1.5 and gestational age suggests that the neonate's creatinine plasma concentration does not simply reflect the mother's plasma concentration.