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Objective Neonates with moderate-to-severe perinatal asphyxia often develop acute kidney injury (AKI). Additionally, therapeutic hypothermia (TH) can affect renal blood flow. This study aimed to evaluate the association between renal regional oxygen saturation (rSrO2) during TH and AKI in neonates with moderate and severe perinatal asphyxia.

Study Design This retrospective longitudinal study included neonates with moderate-to-severe asphyxia who required TH. The primary outcome was the occurrence of AKI, classified as a rate of decrease in creatinine levels of <33% at 72 hours of TH. rSrO2 was continuously monitored by near-infrared spectroscopy during the hypothermia and rewarming phases. Data analysis involved dividing the average rSrO2 levels into 12-hour periods. We analyzed the association between AKI and rSrO2 levels using univariate and multivariate logistic regression models. Furthermore, we assessed the predictive capacity of rSrO2 for AKI by analyzing the area under the receiver operating characteristic curve.

Results Ninety-one patients were included in the study. On average, patients with AKI exhibit lower rSrO2 levels during TH. Specifically, rSrO2 levels within the first 12 hours and between 25 and 72 hours of TH demonstrated the highest predictive capability for AKI. Multivariate logistic regression analysis revealed that rSrO2 levels within the initial 12 hours (adjusted odds ratio [aOR] = 1.11, 95% confidence interval [CI]: 1.01–1.21) and between 61 and 72 hours (aOR = 0.85, 95% CI: 0.78–0.92) were significantly associated with AKI.

Conclusion An increase in rSrO2 during the first 12 hours of TH and lower rSrO2 levels between 61 and 72 hours of treatment were associated with the development of AKI in asphyxiated neonates undergoing TH.

Key Points

Neonates with asphyxia often develop AKI.

Renal saturations are affected by hypothermia and asphyxia

Patients with AKI initially show higher rSrO2, then lower rSrO2.

Monitoring rSrO2 identifies early AKI.

Keywords acute kidney injury - asphyxia neonatorum - infant - newborn - renal regional oxygen saturation - therapeutic hypothermia - spectroscopy - near-infrared Ethical Approval

The study protocol was approved by the Fundación Cardio Infantil—Instituto de Cardiología Ethics Committee (approval no.: CEIC-0602-2022).

Authors' Contributions

S.A-P.: Conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, supervision, validation, writing—original draft, writing—review and editing. G.T.: Conceptualization, formal analysis, methodology, resources, visualization, writing—original draft, writing—review and editing. D.B-R.: data curation, formal analysis, investigation, methodology, supervision, validation, writing—original draft, writing—review, and editing. C.M., A.R., A.V.G., and J.L.: Data curation, formal analysis, investigation, visualization, writing—original draft.

Data Availability

Additional datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Publication History

Received: 25 March 2024

Accepted: 17 July 2024

Accepted Manuscript online:
19 July 2024

Article published online:
13 August 2024

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