Routine Diaper Change Alters Kidney Oxygenation in Premature Infants

Abstract

Background: Reduction in oxygen delivery to developing kidneys of premature infants may be an important source for acute kidney injury in premature infants. Purpose: To describe changes in continuous kidney oxygenation (RrSO2) measures before, during, and after routine diaper changes. Methods: Non–a priori analysis of a prospective cohort that received continuous measurement of RrSO2 with near-infrared spectroscopy (NIRS) over the first 14 days of life demonstrating acute RrSO2 drops surrounding diaper changes. Results: In total, 26 of 38 (68%) infants (≤1800 g) from our cohort exhibited acute drops in RrSO2 that temporally correlated with diaper changes. Mean (SD) RrSO2 baseline prior to each diaper change event was 71.1 (13.2), dropped to 59.3 (11.6) during diaper change, and recovered to 73.3 (13.2). There was a significant difference between means when comparing baseline to diaper change (P < .001; 95% CI, 9.9 to 13.8) and diaper change to recovery (P < .001; 95% CI, −16.9 to −11.2). The mean decrease in RrSO2 during diaper change averaged 12 points (17%) below 15-minute RrSO2 mean prior to diaper change, with quick recovery to prediaper change levels. No decreases in SpO2, blood pressure, or heart rate were documented during the intermittent kidney hypoxic events. Implications for Practice and Research: Routine diaper changes in preterm infants may increase the risk for acute reductions in RrSO2 as measured by NIRS; however, the impact on kidney health remains unknown. Larger prospective cohort studies assessing kidney function and outcomes related to this phenomenon are needed.