Abstract
Background
Creatinine values are unreliable within the first weeks of life; however, creatinine is used most commonly to assess kidney function. Controversy remains surrounding the time required for neonates to clear maternal creatinine.
Methods
Eligible infants had multiple creatinine lab values and were admitted to the neonatal intensive care unit (NICU). A mathematical model was fit to the lab data to estimate the filtration onset delay, creatinine filtration half-life, and steady-state creatinine concentration for each subject. Infants were grouped by gestational age (GA) [(1) 22–27, (2) >27–32, (3) >32–37, and (4) >37–42 weeks].
Results
A total of 4808 neonates with a mean GA of 34.4 ± 5 weeks and birth weight of 2.34 ± 1.1 kg were enrolled. Median (95% confidence interval) filtration onset delay for Group 1 was 4.3 (3.71, 4.89) days and was significantly different than all other groups (p < 0.001). Creatinine filtration half-life of Groups 1, 2, and 3 were significantly different from each other (p < 0.001). There was no difference in steady-state creatinine concentration among the groups.
Conclusions
We quantified the observed kidney behavior in a large NICU population as a function of day of life and GA using creatinine lab results. These results can be used to interpret individual creatinine labs for infants to detect those most at risk for acute kidney injury.
Impact
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One of the largest cohorts of premature infants to describe the evolution of kidney development and function over their entire hospitalization.
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New concept introduced of the kidney filtration onset delay, the time needed for the kidney to begin clearance of creatinine, and that it can be used as an early indicator of kidney function.
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The smallest premature infants from 22 to 27 weeks gestation took the longest time to begin and complete maternal creatinine clearance.
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Clinicians can easily compare the creatinine level of their patient to the normative curves to improve understanding of kidney function at the bedside
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Acknowledgements
D.R.R. is supported by the National Institutes of Health (1K23HLI130522). C.J.R. is supported by the National Institutes of Health (1K23NS091382). C.G.R. is supported by National Institutes of Health (R01HL142994).
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D.R.R. had substantial contributions to the conception and design of the study, interpretation of the data, drafting of the article, and approved the final version. C.J.R. had substantial contributions to the conception and design of the study, interpretation of the data, revised the article critically, and approved the final version. L.E. had substantial contributions to interpretation of the data, revised the article critically for important intellectual content, and approved the final version. K.M.B. had substantial contributions to the conception and design of the study, interpretation of the data, revision of the article critically, and approval of the final version. C.G.R. had substantial contributions to the conception and design of the study, acquisition of data, analysis and interpretation of the data, and revising the article critically and approving the final version. S.A. had substantial contributions to acquisition of data, analysis and interpretation of the data, drafting of the article, revising the article critically, and approving the final version.
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C.G.R. has an SFI in Medical Informatics Corp (MIC). MIC has no financial interests in this work.
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Rios, D.R., Rhee, C.J., Elizondo, L. et al. Creatinine filtration kinetics in critically Ill neonates. Pediatr Res 89, 952–957 (2021). https://doi.org/10.1038/s41390-020-0977-4
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DOI: https://doi.org/10.1038/s41390-020-0977-4
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