Acute Kidney Injury Among Asphyxiated Neonates In Sokoto, North West Nigeria

Background: Birth asphyxia and its attendant complications remain a common problem in our neonatal intensive care units. Compelling evidence from various epidemiologic studies shows that Acute Kidney Injury (AKI) is indeed one of the commonest complications of birth asphyxia. The kidneys are sensitive to oxygen deprivation, renal insult may occur within few hours of hypoxic-ischemic episode, which if prolonged could lead to irreversible cortical and or tubular necrosis. Aim: To determine the prevalence and factors associated with AKI among asphyxiated term neonates in Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria Materials and methods: One hundred and nineteen asphyxiated term neonates admitted into the special care baby unit of UDUTH Sokoto participated in the study. Birth asphyxia was defined as failure to initiate and sustain breathing at birth with Apgar scores ≤ 5 at 5 minutes in the presence of arterial cord blood pH < 7 and base deficit >12mmol. Blood samples were taken for arterial blood gas analysis within one hour of life. Moderately and severely asphyxiated neonates who satisfied the inclusion criteria were consecutively recruited into the study and serum creatinine assay was done on day 3 and day 5 of life. AKI was defined as a rise in serum creatinine ≥ 0.3mg/dl over 48 hours. Quantitative variables such as birth weight, length, occipitofrontal circumference (OFC) were expressed using mean, standard deviation and range, while qualitative variables like gender, mode of delivery and grade of asphyxia were summarised using frequency and percentages. Chisquare and fisher’s exact tests were applied to determine if any relationship exists between sociodemographic/clinical factors and AKI. A p-value of < 0.05 was considered statistically significant. Results: Of the 119 asphyxiated term neonates 74 (62.2%) were males while 45 (37.8%) were females giving a M:F ratio of 1.6:1. Majority 96 (80.7%) of the subjects had normal birth weight with a mean birth weight of 3.1 ± 0.6kg. The mean gestational age recorded was 38.2 ± 1.1 months The prevalence of AKI in the study subjects was 42.9%. The grade of birth asphyxia was significantly associated with AKI with a prevalence odds ratio of 7.2 (95CI 2.8-18). Conclusion: The prevalence of AKI in asphyxiated term neonates in UDUTH Sokoto was high and the grade of birth asphyxia was found to be significantly associated with AKI