Study of neonatal acute kidney injury based on KDIGO criteria.

BACKGROUND: Significant advancement has occurred over the years in diagnosis, recognition, intervention and impact of acute kidney injury (AKI) on morbidity and mortality in critically-ill neonates. However an increased risk of chronic kidney disease (CKD) is still observed among neonates who survive an episode of AKI. Therefore, preventing and adequately managing AKI in neonates could help in controlling long-term renal morbidity in neonates who develop AKI. Thus, this study was undertaken with the aim of studying the incidence, contributing factors and outcomes of AKI in at-risk term neonates admitted to the neonatal intensive care unit (NICU). METHODS: One hundred and ninety-six term neonates admitted to the NICU with sepsis, hypoxic ischemic encephalopathy (HIE), dehydration and respiratory distress were enrolled and evaluated over a period of one year. Detailed maternal history along with neonatal history, anthropometry, vitals and clinical signs of neonates were recorded in a pretested proforma. Urine output was measured in all at-risk neonates. Serum creatinine was estimated to categorize AKI into stages as per modified KDIGO criteria. RESULTS: Incidence of AKI was 21%, (n = 107 out of 510 admissions) in the study. Mortality was significantly higher in AKI stage III neonates (88.9%) (p < 0.001). Multivariate analysis revealed that hypoxic ischemic encephalopathy (HIE) had 35.293 (p < 0.001) times higher risk, while sepsis had 35.701 (p < 0.001), dehydration had 30.260 times (p < 0.001) and respiratory distress had 10.366 times (p < 0.001) higher risk of developing AKI. CONCLUSION: Our study recorded a high incidence of AKI among at-risk neonates. KDIGO criteria for diagnosing AKI is feasible to apply in the at-risk neonates and helps in its early identification. Early diagnosis and timely intervention in neonates with HIE, sepsis, dehydration and respiratory can prevent the progression of AKI and thus improve prognoses.

Topical-steroid-induced iatrogenic Cushing syndrome in the pediatric age group: A rare case report.

Cushing syndrome, a systemic disorder, is the result of abnormally high blood level of cortisol or other glucocorticoids. The most common cause of Cushing syndrome is prolonged exogenous administration of glucocorticoid hormones. Prolonged use of topical corticosteroids, particularly in children, may cause Cushing syndrome and suppression of the hypothalamopituitory-adrenal axis, which is less common than that of oral or parenteral route. However, iatrogenic Cushing syndrome in the infantile age group due to topical steroid is very rare and only a few patients have been reported to date in the literature. Here we report a case of iatrogenic Cushing syndrome due to topical steroid application in a 5-month-old female child admitted to the hospital for repeated episodes of fever and cough.

Nucleated red blood cell in cord blood as a marker of perinatal asphyxia.

BACKGROUND: Perinatal asphyxia is a major cause of neurological morbidity and mortality in India. The purpose of this study was to investigate variations in nucleated red blood cell (NRBC) in blood associated with perinatal asphyxia and its relationship to both the severity and short term prognosis of asphyxia. METHODS: A prospective (case-control) study was undertaken at Gandhi Medical College and Associated Hospitals. A total of 100 neonates were included in the study. Levels of NRBC/100 white blood cells (WBC) and absolute NRBC counts in cord blood were compared for 50 asphyxiated (case group) and 50 normal neonates (control group). These parameters were also related to the severity of asphyxia and clinical outcome. RESULTS: The number of NRBC/100 WBC in the blood of 50 newborns each in the asphyxiated and in the control group were mean 29.5 ± 26.0, range 7-144 NRBCs/100 WBC and mean ± standard deviation 5.9 ± 2.6, range 3-14 NRBCs/100 WBC respectively (P < 0.01). Using quartile deviation, staging of hypoxic ischemic encephalopathy (HIE) was done on basis of NRBC count and there was 80% agreement between clinical and NRBC staging of HIE. There was a significant (P < 0.01) correlation of the number of NRBC\100 WBC with Apgar scoring, HIE staging and mortality. CONCLUSIONS: The NRBCs/100 WBCs can be used as a simple marker for the assessment of severity and early outcome of perinatal asphyxia.