Acute renal failure in neonatal septicemia

Abstract

Objective : To find out the prevalence, associate factors and outcome of acute kidney injury in neonatal sepsis. Methods : An observational hospital based prospective study was conducted at outborn NICU, Bal Chikitsalya, RNT Medical College, Udaipur (Raj.) India from august 2015 to January 2016. We enrolled total 107outborne neonates with sepsis, were evaluated for presence of ARF or not Sepsis was diagnosed on the basis of either a positive sepsis screen (immature: total (I:T) neutrophil ratio > 0.2, ? -ESR > age in days + 2 mm or >15 mm, CRP> 1mg/dl, TLC 5000 cells/mm³ or >15000/ mm³; 2 or more positive) or a positive blood culture in symptomatic neonates. ARF was defined as creatinine >1.5 mg/dl irrespective of day of life. Oliguria was defined as urine output 1ml/Kg/hr. Results: 34 out of 107 (21.49%) neonates with sepsis had ARF; only 20.58% of ARF was oliguric. The mean gestation of neonates with ARF was similar to those without ARF (34.732.88wks vs. 34.523.17wk). The association of shock was also significantly higher in neonates with ARF (70.59% vs 29.41%, p 0.001). Mortality in neonates who developed ARF was significantly higher (56.52% vs 25%, p 0.001). Conclusion: Renal failure occurred in 21.49% neonates with sepsis. Although ARF in neonates has been reported to be predominantly oliguric, it was observed that ARF secondary to neonatal sepsis was predominantly non oliguric. Very Low birth weight was an important risk factor for the development of ARF.