Potential risk factors for the development of acute renal failure in preterm new born infants: a case-control study
Potential risk factors for the development of acute renal failure in preterm new born infants: a case-control study
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DOI：
10.1136/adc.2004.060434
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发表时间：
2005-11-01
影响因子：
4.4
通讯作者：
Cuzzolin, L
中科院分区：
文献类型：
--
作者：
Cataldi, L;Leone, R;Cuzzolin, L
目的：在病例对照研究中确定早产新生儿急性肾功能衰竭的发展与治疗干预措施，特别是药物治疗之间可能存在的关联。研究人群为172例妊娠< 38周的早产儿，其中71例为急性肾功能衰竭，101例为胎龄和出生体重密切匹配的对照组。通过问卷调查和访谈收集两组产妇和新生儿的信息。还收集了肾脏变量的常规数据。结果：极低出生体重儿是急性肾功能衰竭的高危儿（79%的病例< 1500 g）。然而，急性肾衰竭为一过性。患有急性肾功能衰竭婴儿的母亲在怀孕和分娩期间接受更多药物（主要是抗生素和非甾体抗炎药）。在可能的治疗干预中，插管、导管插入和光疗主要应用于病例受试者。新生儿急性肾功能衰竭中，有较高比例的新生儿被诊断为低Apgar评分和动脉导管未闭。此外，在出生后的最初几天和诊断为急性肾衰竭之前，病例受试者接受了更多的药物（抗生素、非甾体抗炎药和利尿剂）和更长的时间。在多变量logistic分析中，髓质强回声（比值比（OR）4.491; 95%置信区间（0）1.879至10.731）和头孢他啶给药（OR 5.082; 95%CI 1.493 ~ 17.297）与急性肾功能衰竭的风险增加相关。研究结果表明，需要对极低出生体重儿进行仔细监测，并注意药物治疗，因为在生命的最初几天很难区分正常和肾衰竭。
Aims: To determine in a case-control study possible associations between the development of acute renal failure in preterm newborns and therapeutic interventions, particularly drug treatments.Methods: The study population was 172 preterm infants of < 38 weeks gestation; 71 had acute renal failure and 101 were controls closely matched for gestational age and birth weight. Maternal and neonatal information was collected for both groups through questionnaires and interviews. Routine data on renal variables were also collected. Univariate and multivariate logistic regression analyses were performed.Results: Very low birthweight infants were at high risk of acute renal failure (79% of cases were < 1500 g). However, the acute renal failure was transient. Mothers of infants with acute renal failure received more drugs during pregnancy and delivery (mainly antibiotics and non-steroidal anti-inflammatory drugs). Of the possible therapeutic interventions, intubation, catheterisation, and phototherapy were mainly applied to case subjects. A low Apgar score and patent ductus arteriosus were diagnosed in a greater percentage of neonates with acute renal failure. Moreover, in the first few days of life and before diagnosis of acute renal failure, case subjects received more drugs (antibiotics, non-steroidal anti-inflammatory drugs, and diuretics) and for a longer time. in the multivariate logistic analysis, medullary hyperechogenicity (odds ratio (OR) 4.491; 95% confidence interval (0) 1.879 to 10.731) and ceftazidime administration (OR 5.082; 95% CI 1.493 to 17.297) were associated with a greater risk of acute renal failure.Conclusions: The results suggest the need for careful monitoring of very low birthweight infants and attention to drug treatments, as it is difficult to differentiate between normality and renal failure in the first few days of life.