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a Department of
Neonatology, The Qeen Mother's Hospital, Glasgow G3 8SJ, UK, b Department of Paediatrics and
Neonatology, Southern General Hospital, Glasgow G51 4TF, UK, c Department
of Biochemistry, Stobhill Hospital, North Glasgow University Hospitals
NHS Trust, Balomock Road, Glasgow G21 3UW, UK, d Department
of Radiology, The Royal Hospital for Sick Children, Yorkhill, Glasgow
G3 8SJ, UK, e Department of
Statistics, University of Glasgow, Glasgow G12 8QQ, UK, f The Renal Unit, The Royal Hospital for
Sick Children, Yorkhill, Glasgow G3 8SJ, UK
Correspondence to: Dr Narendra, SCBU, Homerton Hospital, Homerton Row, London E9 6SR, UK N.Aladangady{at}qmw.ac.uk
Accepted 14 August
2001
OBJECTIVES
To
determine prospectively the incidence and cause of nephrocalcinosis in
preterm infants.
STUDY DESIGNInborn
babies of gestation less than 32 weeks or birth weight less than 1500 g
were eligible to be entered into a prospective observational study. Two
renal ultrasound scans were performed, the first at 1 month postnatal
age and the second at term or discharge. Data were collected on
gestation, birth weight, sex, race, family history of renal calculi,
oliguria on first day, respiratory support (ventilation, steroid, and
oxygen dependency), and use of nephrotoxic drugs (gentamicin,
vancomycin, and frusemide). Intake of fluid, calcium, and phosphate
and plasma urea, creatinine, calcium, and phosphate were recorded for
the first 6 weeks of life. Random urinary calcium/creatinine,
oxalate/creatinine, and urate/creatinine ratios and tubular absorption
of phosphate were measured once at term.
RESULTSA total of 101 preterm infants were studied. Twenty three (23%) had abnormal
ultrasound scans. Sixteen (16%) had nephrocalcinosis. On univariate
analysis, gestational age, male sex, duration of ventilation, oxygen
dependency, duration and frequency of gentamicin treatment, toxic
gentamicin/vancomycin levels, and postnatal dexamethasone were
significantly associated with nephrocalcinosis. In addition, babies
with nephrocalcinosis had a lower intake of fluid, calcium, and
phosphate, longer duration of total parenteral nutrition, and higher
urinary oxalate/creatinine and urate/creatinine ratios than infants who
did not have the condition. There was also a significant association
with plasma urea and creatinine but not with plasma calcium or
phosphate or urinary calcium. Multivariate analysis showed that the
strongest predictors of nephrocalcinosis were duration of ventilation,
toxic gentamicin/vancomycin levels, low fluid intake, and male sex.
CONCLUSION16% of
babies born at less than 32 weeks gestation developed nephrocalcinosis.
The multifactorial origin, in particular, the association with extreme
prematurity and severity of respiratory disease, is confirmed. In
addition, an association with male sex, frequency and duration of
gentamicin use, and high urinary oxalate and urate excretion is shown.
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