Perinatal factors can impair renal adaptation at birth. VLGAN are at increased risk of renal failure, partly due to drugs needed for their care. The objective of this study was to determine the weight of perinatal and therapeutic factors in decreased glomerular filtration (GFR) rate in VLGAN.
Methods Case-control study nested in a prospective multicentric cohort of infants aged 27–31 weeks gestation (GA). Infants were included on day 2 and parted in two groups defined by GFR (mL/min/1.73 m2) on day 7: median = 14.7; Group 1: GFR<14.7; Group 2: GFR>14.7. Renal function was measured weekly for a month.
Results 238 VLGAN were included. Risk factors for altered GFR on day 7 were GA (group 1: 70% <29 wks GA vs. group 2: 33% p<10–4), hyaline membrane disease (57% vs. 38% p<10–2), nephrotoxic drug use before day 7 (68% vs. 36% p<10–4), and a tendency for anaemia (57% vs. 41% p = 0.08). Gender, intra-uterine growth restriction, antenatal steroids, hypotension were not associated with decreased GFR. On logistic regression, risk factors of low GFR were GA<29 wks OR = 3.6 CI95% = [1.7 to 6.5] and nephrotoxic drugs OR = 2.4 [1.1 to 5.0]. GFR remained significantly decreased in Group 1 during the first month of life (Day 7: 11.0±2.5 vs. 20.2±4.6 mL/min/1.73 m2 p<10–4; Day 14: 14.2±3.7 vs. 16.6±4.7 p<10–2; Day 28 19.5±7.6 vs. 23.2±9.3 p = 0.02).
Conclusion Nephrotoxic drugs should be handled carefully in VLGAN <29 weeks GA, as it may impair renal function for the first month of life.
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