Renal Oxygen Saturations and Acute Kidney Injury in the Preterm Infant with Patent Ductus Arteriosus

Abstract

Objective Decreased near-infrared spectroscopy (NIRS) measures of renal oxygen saturation (Rsat) have identified preterm infants with a hemodynamically significant patent ductus arteriosus (hsPDA). NIRS may further identify infants at risk for acute kidney injury (AKI) in a population with concern for hsPDA. Study Design Review of infants ≤29 weeks' gestation undergoing NIRS and echocardiography due to concern for hsPDA. The hsPDA was defined by two of the following: moderate-large size, left to right shunt, aortic flow reversal, left atrial enlargement. AKI was defined by neonatal modified Kidney Disease Improving Global Outcomes (KDIGO). Rsat and cerebral saturation (Csat), averaged over 1 hour, were evaluated for the 24-hour period around echocardiography. Results Among 77 infants, 29 (38%) had AKI by neonatal modified KDIGO criteria. hsPDA was found on echocardiography in 59 (77%). There were no differences in hsPDA in infants with and without AKI (p = 0.1). Rsat was not associated with AKI (p = 0.3). Infants on dopamine had less Rsat variability (p < 0.01). Conclusion Rsat prior to echocardiography did not discriminate AKI in this cohort of preterm infants at risk for hsPDA; however, data may not capture optimal timing of Rsat measurement before AKI. Key Points