Plasma creatinine rises dramatically in the first 48 hours of life in preterm infants
Plasma creatinine rises dramatically in the first 48 hours of life in preterm infants
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DOI：
10.1542/peds.104.6.e76
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发表时间：
1999-12-01
期刊：
影响因子：
8
通讯作者：
Allgar, VL
中科院分区：
文献类型：
--
作者：
Miall, LS;Henderson, MJ;Allgar, VL
目标。已发表的数据显示，血浆肌酐在出生后的28天内稳定下降，而新生儿期的肌酐水平在更多早产儿中较高。然而，最好的参考数据开始于生命的第2天。本研究的目的是记录血浆肌酐在出生后48小时内的变化情况，并探讨与母亲相比，早产儿明显较高的肌酐水平的原因。地区新生儿重症监护病房的前瞻性观察研究。共42例早产儿，平均胎龄29.4周（范围：23 ~ 35），平均出生体重1.42 kg(0.55 ~ 2.77)，分为4个妊娠组：23 ~ 26周（n = 9）， 27 ~ 29周（n = 13）， 30 ~ 32周（n = 12）， 33 ~ 35周（n = 8）。脐带血及常规动脉血气分析系列样品血浆肌酐和尿素浓度的测定。结果测量。肌酐浓度随时间的变化以及与胎龄、出生体重和疾病严重程度的关系。出生时平均肌酐为73 mmol/L（95%可信区间[CI]: 68-79 mmol/L）。血浆肌酐在头48小时内显著升高。大多数早产儿（23 ~ 26周）肌酐平均峰值为221 mu mol/L （CI: 195 ~ 247 mu mol/L）。血浆肌酐峰值与妊娠期呈负相关（Spearman系数：2）。73)和出生体重（斯皮尔曼系数：- 0.76）。不同妊娠组在24和48小时的肌酐浓度有显著差异。肌酸酐峰值与婴儿临床风险指数评分高相关（Spearman系数：0.64）。在更多的早产儿中，肌酸酐的下降开始得较晚。38例存活婴儿肾功能正常；出院时平均血浆肌酐为52 mmol/L （CI: 46 ~ 58 μ mol/L）。肌酐不是从出生开始就稳步下降，而是在生命的头48小时内急剧上升，尤其是在婴儿中
Objective. Published data show that plasma creatinine falls steadily during the first 28 days of life and that creatinine levels in the neonatal period are higher in more premature infants. However, the best reference data commence on day 2 of life. The objective of this study was to document how plasma creatinine changes in the first 48 hours of life and to examine the reason for the apparently high levels of creatinine in preterm infants, compared with maternal levels.Design. A prospective observational study on a regional neonatal intensive care unit.Patients. A total of 42 preterm infants, mean gestational age of 29.4 weeks (range: 23-35), mean birth weight of 1.42 kg (.55-2.77), divided into 4 gestation groups: 23 to 26 weeks (n = 9), 27 to 29 weeks (n = 13), 30 to 32 weeks (n = 12), and 33 to 35 weeks (n = 8).Interventions. Measurement of plasma creatinine and urea concentration in cord blood and in serial samples taken for routine arterial blood gas analysis.Outcome Measurements. Changes in creatinine concentration with time and relationship to gestational age, birth weight, and illness severity.Results. Mean creatinine at birth was 73 mu mol/L (95% confidence interval [CI]: 68-79 mmol/L). Plasma creatinine rose significantly over the first 48 hours. Mean peak creatinine in the most preterm infants (23-26 weeks) was 221 mu mol/L (CI: 195-247 mu mol/L). Peak plasma creatinine was inversely related to gestation (Spearman's coefficient: 2. 73) and birth weight (Spearman's coefficient: -.76). Significant differences in creatinine concentration were seen among different gestational groups at 24 and 48 hours of life. Peak creatinine correlated with a high Clinical Risk Index for Babies score (Spearman's coefficient: .64). The fall in creatinine began later in more premature infants. All 38 surviving infants had normal renal function; their mean plasma creatinine at discharge was 52 mmol/L (CI: 46-58 mu mol/L).Conclusions. Rather than falling steadily from birth, creatinine rises dramatically in the first 48 hours of life, especially in infants of