Renal follow up of premature infants with and without perinatal indomethacin exposure
R Ojalaa, M Ala-Houhalaa, S Ahonenb, A Harmoinenc, V Turjanmaad, S Ikonena, O Tammelaa
a Department of
Paediatrics, Tampere University Hospital, PO Box 2000, FIN 33521, Tampere, Finland, b Department of Radiology,
Tampere University Hospital, c Department of Clinical Chemistry, Tampere
University Hospital, d Department
of Clinical Physiology, Tampere University Hospital
Correspondence to: Dr Ojala riitta.l.ojala{at}uta.fi
Accepted 10 August
2000
AIMS
To evaluate early childhood
renal growth, structure, and function in children born at less than 33 weeks gestation and to investigate possible independent effects of
perinatal indomethacin exposure.
METHODSA total of 66 children born
at less than 33 weeks gestation, 31 of them with perinatal indomethacin
exposure (study group) and 35 without (control group), were examined at
2-4 years of age. Serum cystatin C and protein; plasma creatinine,
sodium, and potassium; urine protein, calcium:creatinine ratios, and
1 microglobulin; and glomerular filtration rate (GFR)
were determined. Renal sonography examinations were performed.
RESULTSThe mean serum cystatin C
concentrations were slightly higher in the control group than in the
study group. Mean values of serum protein, and plasma creatinine and
sodium did not differ between the groups, neither did median plasma
potassium concentrations and urine protein:creatinine and
calcium:creatinine ratios. None had tubular proteinuria. Abnormal GFR
(<89 ml/min/1.73 m2) was found in one case in each group
and renal structural abnormalities in five in each group. In logistic
regression analysis the duration of umbilical artery catheter (UAC) use
and furosemide treatment emerged as the significant independent risk
factors for renal structural abnormalities. Furosemide treatment and
assisted ventilation remained the risk factors associated with renal
abnormalities in generalthat is, functional and/or structural
abnormal findings.
CONCLUSIONPerinatal indomethacin
does not seem to affect long term renal growth, structure, or function
in children born at less than 33 weeks gestation. Duration of UAC use,
furosemide treatment, and assisted ventilation may be correlated with
later renal structural and functional abnormalities.
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Key messages
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Keywords: preterm infants; indomethacin; renal; follow up
© 2001 by Archives of Disease in Childhood
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