Renal follow up of premature infants with and without perinatal indomethacin exposure
- aDepartment of Paediatrics, Tampere University Hospital, PO Box 2000, FIN 33521, Tampere, Finland, bDepartment of Radiology, Tampere University Hospital, cDepartment of Clinical Chemistry, Tampere University Hospital, dDepartment of Clinical Physiology, Tampere University Hospital
- Dr Ojalariitta.l.ojala{at}uta.fi
- Accepted 10 August 2000
Abstract
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.
METHODS A 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 α1 microglobulin; and glomerular filtration rate (GFR) were determined. Renal sonography examinations were performed.
RESULTS The 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 general—that is, functional and/or structural abnormal findings.
CONCLUSION Perinatal 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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Renal structural abnormalities occur commonly in children who were born prematurely at less than 33 weeks gestation
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There is an association between the duration of umbilical artery catheter use and furosemide treatment in the neonatal period with later renal structural abnormalities
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Premature infants who require umbilical artery catheterisation and furosemide therapy constitute a high risk group in whom follow up of renal function is indicated
