Perinatal Risk Factors of Cardiovascular-Renal Outcome in former Extremely Low Birth Weight neonates

Abstract

Abstract Background Former Extremely Low Birthweight (ELBW) neonates suffer from adverse renal and cardiovascular outcomes later in life. Less is known about additional perinatal risk factors and their similarity for these adverse outcomes. Methods We compared cardiovascular-renal outcome between ELBW children and controls, to find perinatal risk factors for poorer renal and cardiovascular outcome and to unveil associations between kidney function and blood pressure. This study included 93 ELBW children and 87 healthy controls. We measured cystatin C-based estimated glomerular filtration rate (eGFR) and blood pressure. Blood pressure and eGFR levels were compared between cases and controls. We subsequently investigated perinatal risk factors for adverse outcome amongst ELBW children. Results ELBW children have significantly higher blood pressure and lower eGFR. Elevated blood pressure did not correlate with perinatal characteristics. ELBW children with eGFR < 90 ml/min/1.73m2 were ventilated longer (17 vs. 9 days, p = 0.006), more frequently male (OR = 3.33, p = 0.055) and tended to suffer more from intraventricular hemorrhage (40% vs. 15.8%, p = 0.056). There was no association between blood pressure and kidney dysfunction. Conclusions Understanding risk profiles for unfavorable outcomes may help to identify children at increased risk for kidney or cardiac dysfunction. These risk profiles could be different for renal and cardiovascular outcome. Poorer eGFR was associated with longer ventilation, male sex, and intra-ventricular hemorrhage. This knowledge can lead to safer neonatal therapeutic regimens for ELBW infants, a more intensive follow-up and earlier treatment initiation for children at highest risk.