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Yen CW, Chiang MC, Chu SM, Wang HC, Wu LC, Yen PC, Yu MC. Sustained acute kidney injury as an independent risk factor for neurodevelopmental and growth outcomes in a single NICU center. BMC Pediatr 2024; 24:233. [PMID: 38566029 PMCID: PMC10985966 DOI: 10.1186/s12887-024-04568-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 01/15/2024] [Indexed: 04/04/2024] Open
Abstract
PURPOSE Acute kidney injury (AKI) is commonly seen in neonatal intensive care units (NICUs) and is potentially associated with adverse prognoses in later stages of life. Our study evaluated the impact of sustained AKI (SAKI) on both neurodevelopmental impairment (NDI) and early growth restriction (EGR) in neonates. METHODS This case-control study retrospectively analyzed the medical records of neonates diagnosed with SAKI in the NICU of a tertiary medical center during the period from January 2007 to December 2020. Cases without subsequent follow-up and those resulting in death were excluded. We analyzed demographic, biochemical, and clinical outcome data. RESULTS Of the 93 neonates with SAKI, 51 cases (54.8%) were included in this study, while 42 cases (45.2%) were excluded due to a lack of follow-up or death. An age-matched control group comprised 103 neonates, who had never experienced AKI or SAKI, were selected at random. In total, 59 (38.3%) cases were identified as NDI and 43 (27.9%) as EGR. Multivariate analysis revealed that patients with SAKI had significantly higher risks of developing NDI (odds ratio, [OR] = 4.013, p = 0.001) and EGR (OR = 4.894, p < 0.001). The AKI interval had an area under the receiver operating characteristic curve of 0.754 for NDI at 9.5 days and 0.772 for EGR at 12.5 days. CONCLUSIONS SAKI is an independent risk factor for both NDI and EGR in neonates. Consequently, regular monitoring, neurological development assessments, and appropriate nutritional advice are crucial to these infants who have experienced renal injury.
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Affiliation(s)
- Chen-Wei Yen
- Department of Pediatric Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Pediatric General Medicine, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Chou Chiang
- Department of Neonatology, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Ming Chu
- Department of Neonatology, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsiao-Chin Wang
- Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, New Taipei, Taiwan
- Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Chun Wu
- Department of Neonatal Intensive Care Unit, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Po-Cheng Yen
- Department of Pharmacy Administration, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mei-Ching Yu
- Department of Pediatric Nephrology, Lin-Kou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Department of Pediatric Nephrology, Lin-Kou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, 5 Fusing Street, Gueishan, Taoyuan, 333, Taiwan.
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Al-Hindi MY, Qari SA, Fatani WA, Alshaban RM, Felemban NS, Altowairqi JM, AlQurashi MA. Accuracy of Umbilical Cord Complete Blood Count in Detecting Early-Onset Neonatal Thrombocytopenia. Cureus 2023; 15:e50503. [PMID: 38222232 PMCID: PMC10787347 DOI: 10.7759/cureus.50503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND Neonatal thrombocytopenia (NTCP) is a common hematological disorder whose platelet count falls below the normal limit of 150 x 109/L. NTCP can cause late complications if left untreated. The current study aimed to evaluate the accuracy of the umbilical cord complete blood count (UC CBC) in detecting early-onset neonatal thrombocytopenia (EO-NTCP). Further, the prevalence of NTCP was also investigated. Methods: A cross-sectional study with a matched control was conducted on all newborns delivered at a tertiary care center in Jeddah, Saudi Arabia, between May 2016 and 2019. After exclusions, 40 neonates with EO-NTCP (cases) and 80 without EO-NTCP (controls) were included. The case-to-control ratio was 1:2. The results of UC CBC were compared with those of follow-up CBC, performed within 72 hours. A p-value of <0.05 was considered statistically significant. All data were analyzed using IBM SPSS version 28 for Windows (IBM Corp., Armonk, NY). RESULTS The prevalence of NTCP was approximately 1.02% (111/10,936). Lack of antenatal care was found in 12 (30%) neonates with EO-NTCP vs. 10 (12.5%) neonates without EO-NTCP (p = 0.02). Neonates with EO-NTCP were more likely to have experienced intrauterine growth restriction (5 (37.5%) vs. 5 (6.3%), p < 0.001) and oligohydramnios (5 (12.5%) vs. 0 (0%), p = 0.003). Neonates who developed EO-NTCP were more likely to be admitted to the NICU (34 (85%) vs. 35 (43.8%), p < 0.001) and receive antibiotics (22 (55%) vs. 25 (31.3%), p = 0.012). Also, neonates with EO-NTCP were more frequently diagnosed with neonatal sepsis (7 (17.5%) vs. 3 (3.8%), p = 0.015) and more likely to receive platelet transfusions (15 (37.5% vs. 1 (1.3%), p < 0.001). They also had a higher median length of hospital stay (13 (interquartile range (IQR) 3-28) vs. 4 (IQR 2-9) days, p = 0.006). The mortality rates of neonates with EO-NTCP and those without were 6 (15%) vs. 2 (2.5%) neonates (p = 0.016). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of UC CBC were 62.50%, 97.50%, 20.40%, and 99.61%, respectively. CONCLUSION The prevalence of EO-NTCP in King Abdulaziz Medical City is comparable to international and national figures, and it is associated with preceding maternal comorbidities, serious neonatal morbidity, and even mortality. Therefore, proper antenatal care is vital in preventing maternal and neonatal morbidities, including the risks of NTCP and its related complications. With high NPV, using UC CBC as a universal screening method could assist in safely discharging newborns. However, because of its low sensitivity, a comprehensive clinical examination with confirmatory laboratory tests are still the cornerstone in diagnosing EO-NTCP. Future trials should aim to study the cost-effectiveness of universal UC CBC and the long-term outcomes of infants diagnosed with EO-NTCP.
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Affiliation(s)
- Mohammed Y Al-Hindi
- Pediatrics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Western Region, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Sherin A Qari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Wed A Fatani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Raneem M Alshaban
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Nooran S Felemban
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Jood M Altowairqi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Mansour A AlQurashi
- Pediatrics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Western Region, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
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Varela-Moraga V, Diethelm-Varela B, Pérez-Pereira M. Effect of biomedical complications on very and extremely preterm children's language. Front Psychol 2023; 14:1163252. [PMID: 37484104 PMCID: PMC10361768 DOI: 10.3389/fpsyg.2023.1163252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 06/05/2023] [Indexed: 07/25/2023] Open
Abstract
Introduction Very and extremely preterm children have been found to show delays in the development of language in early years. In some investigations, however, a rigorous control of biomedical complications, such as Periventricular Leukomalacia (PVL), Intraventricular Hemorrhage (IVH) or Bronchopulmonary Dysplasia (BPD), does not always exist. For that reason, a confounding effect of low gestational age and biomedical complications may lead to erroneous conclusions about the effect of gestational age. Methods In this investigation we compare language development [use of words, sentence complexity and mean length of the three longest utterances (MLU3)] of three groups of Chilean children at 24 months of age (corrected age for preterm children). The first group was composed of 42 healthy full-term children (Full term group: FT), the second group of 60 preterm children born below 32 gestational weeks without medical complications (low risk preterm group: LRPT), and the third group was composed of 64 children below 32 gestational weeks who had medical complications (High risk preterm group: HRPT). The three groups were similar in terms of gender distribution, maternal education, and socio-economic environment. The instrument used to assess language was the Communicative Development Inventories (CDI). In addition, the Ages and Stages Questionnaire-3 (ASQ-3) was also used to assess other developmental dimensions. Results The results indicate that HRPT and LRPT children obtained significantly lower results than the FT group in the three language measures obtained through the CDI. No significant differences were observed between the HRPT and the LRPT groups, although the HRPT obtained the lowest results in the three CDI measures. The results obtained through the administration of the ASQ-3 confirm the delay of both preterm groups in communicative development when compared to the FT group. No significant differences between the FT and the PT groups were observed in gross motor, fine motor and problem solving dimensions of the ASQ-3. The LRPT group obtained results that were significantly higher than those of the FT group and the HRPT group in gross motor development. Discussion These results seem to indicate that the area of language development is particularly influenced by very or extremely low gestational age.
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Affiliation(s)
- Virginia Varela-Moraga
- Departamento de Fonoaudiología, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Benjamín Diethelm-Varela
- Department of Molecular Genetics and Microbiology, School of Biological Sciences, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Miguel Pérez-Pereira
- Departamento de Psicoloxía Evolutiva e da Educación, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
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Alzahrani A, Alahmadi RA, Alghamdi SK, AlQurashi RA, Al-Hindi MY. Determinants of Acute Kidney Injury in Children Undergoing Cardiopulmonary Bypass: Single-Center Experience in Saudi Arabia. Cureus 2022; 14:e32666. [PMID: 36540319 PMCID: PMC9760221 DOI: 10.7759/cureus.32666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Cardiopulmonary bypass (CPB) is a machine used in open cardiac surgeries and has been linked to many complications, one of which is acute kidney injury (AKI). Also, the Kidney Disease Improving Global Outcomes (KDIGO) criteria are used to diagnose AKI in the pediatric population. The study aimed to investigate the association between cardiopulmonary bypass duration and renal function impairment in pediatric patients who had cardiac surgery. Methods This was an observational, cross-sectional study conducted at the King Abdulaziz Medical City, King Faisal Cardiac Center, the section of the Pediatric Cardiac Intensive Care Unit (PICU), Ministry of National Guard Health Affairs, from January 2016 to December 2019. Patients younger than 14 years old, those having a cardiac surgery where CPB was implemented, normal pre-operative kidney functions, and having a cardiac surgery longer than 60 minutes (min) were included. The exclusion criteria were patients known to have pre-operative renal impairment and patients with pre-operative hemodynamic instability or cardiac arrest. Demographics of pre-operative, intra-operative, and post-operative data were extracted, and Statistical Package for the Social Sciences (SPSS) version 25 (Armonk, NY: IBM Corp.) was used for analysis. For descriptive statistics, frequencies and percentages for qualitative data were examined, while mean and standard deviation (SD) or median and interquartile range (IQR) quantitative data were used accordingly. Student's t-test, Mann-Whitney (median test), chi-square, or Fisher's exact tests were used for univariate analysis accordingly. Logistic regression analysis was used to determine significant predictors for developing AKI. A p-value of <0.05 would be considered significant. Results Of the 111 patients, 87 patients were included in the analysis. The median age was six months, IQR two to 13 months, body mass index (BMI) mean of 13.8, and SD 3.6. There was similar sex distribution, male 47.1% vs. female 52.9%. There were no patients in Risk Adjustment for Congenital Heart Surgery (RACHS) who scored 5 or 6. The AKI prevalence was 31% (27/87) within three days after surgery. One patient had stage 2 AKI; the rest were mild. One patient (3.7%) died. The CPB time was significantly longer in patients who developed AKI 150 (104-202), vs. non-AKI 104 (82-142) min, p=0.004. In the AKI group, the mean baseline (pre-operative) serum creatinine (sCr) was significantly lower, whereas, it was significantly higher at 24 hours (h), and 48 h post-operation (p=0.001, 0.001, and 0.036, respectively). Additionally, the estimated Glomerular Filtration Rate (eGFR) was significantly higher in the AKI group at 24 h (p=0.007). In logistical regression analysis, CPB time (per min unit time) was a significant predictor for developing AKI, OR 1.015, p=0.011 as a measured outcome. However, only CPB time >180 min was highly significant with OR 16.2, p=00.6 compared to CPB time 121-180 min OR 2.3, p=0.29 and CPB time 91-120 min OR 1.2, p=0.84. Conclusion Acute kidney injury is an expected complication of pediatric congenital heart surgery receiving CPB. Although in our single-center experience, CPB duration was a significant predictor for AKI; however, it is considered a mild complication that does not contribute significantly to short-term morbidity or mortality. A larger multicenter, national prospective data registry is recommended to explore long-term effects.
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Affiliation(s)
- Abdullah Alzahrani
- Pediatrics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
| | - Raghad A Alahmadi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Sara K Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, jeddah, SAU
| | - Rahaf A AlQurashi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | - Mohammed Y Al-Hindi
- Pediatrics, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, SAU
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
- Research and Development, King Abdullah International Medical Research Center, Jeddah, SAU
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Faden YA, Fatani AM, Fallatah BM, Rawa TS, Almasri SA, El Amin NO, Rawas SA, Al-Hindi MY. Examining the Association Between Episiotomy and Severe Perineal Tears in a Tertiary Care Center Implementing a Restrictive Episiotomy Policy. Cureus 2022; 14:e31606. [DOI: 10.7759/cureus.31606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 11/19/2022] Open
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