الفهرس 
Acknowledgement
Chapter 1: Perinatal AsphyxiaOnly 14 pages are availabe for public view
 |  | from | 133 |  |  |
| | | from | 133 | | |
Abstract
Acute kidney injury is an independent risk factor for neonatal death. Its incidence is reported to be about 8%- 24% in neonates hospitalized in a neonatal intensive care unit, and its mortality is approximately 10 %-61 %. Early renal injury is a potentially reversible syndrome characterized by a sharp decline in the glomerular filtration rate. Since neonatal early renal injury usually has no specific clinical symptoms, many AKI cases are often missed the best time of early intervention if there is no targeted examination.
Perinatal asphyxia can lead to significant systemic and neurological problems because of the reduction of blood flow and/or oxygen to a fetus or infant during the process of birth. One of these complications of perinatal asphyxia was acute kidney injury.
SCr and BUN are classic indicators for clinical detection of kidney injury. Several studies have confirmed that creatinine of newborns reflects creatinine level of the mother during the first two days of life; creatinine level of full-term healthy newborns gradually decreases with the days after birth and stabilizes to a normal level two weeks after birth.
The current study was conducted at neonatal intensive care unit of Assiut University Children Hospital through the period from January 2019 to January 2021. A total of 70 full-term neonates who were admitted to neonatal intensive care unit with documented perinatal asphyxia were enrolled in the study.
The study aimed to assess efficacy of Cystatin C as an early predictor of acute kidney injury in those neonates with perinatal asphyxia. Out of those 70 neonates included in the study; 21 (30%) neonates developed acute kidney injury while the other 49 (70%) neonates didn’t develop acute kidney injury.
In the current study, both groups (group 1 (with AKI), group 2 (without AKI)) had insignificant difference as regard baseline data with except of significantly lower birth weight among acute kidney injury group (2.83 ± 0.65 vs. 3.19 ± 0.56 (kg)). Also, acute kidney injury group had significantly high frequency of LBW neonates < 2500 g (57.1% vs. 28.6%). Neonates with acute kidney injury had significantly higher frequency of antepartum hemorrhage, mechanical ventilation, hypotension and usage of inotropes.
Also, we found that majority (61.2%) of non- acute kidney injury group had stage-I hypoxic ischemic encephalopathy while majority (61.9%) of those with acute kidney injury had stage-III with significant differences between both groups. Majority (95.9%) of group 2 were discharged in a good condition and only two patients without acute kidney injury were died. Meanwhile, 10 (47.6%) patients of those with acute kidney injury were deteriorated and died with significant differences between both groups. Also, length of stay was significantly longer among those with acute kidney injury (8.28 ± 2.14 vs. 5.41 ± 1.32 (day)).
The main finding in the current study was that significantly higher serum Cystatin C among acute kidney injury group (1.50 ± 0.12 vs. 0.90 ± 0.14). Based on the current study; the predictors for acute kidney injury among neonates with PA were LBW, Cystatin C, hypotension and stage-III hypoxic ischemic encephalopathy. It was found that serum Cystatin C has 94.3% overall accuracy for prediction of acute kidney injury in comparison to 68.6% for hypotension , 66.8 % for LBW and 84.4 % for stage Ⅲ HIE.
In conclusion, acute kidney injury in neonates with perinatal asphyxia is fairly common. Cystatin C is a promising biomarker in early prediction of acute kidney injury in such cases.