Nonoliguric and oliguric acute renal failure in asphyxiated term neonates

The purpose of this study was to determine the prevalence and types of acute renal failure in asphyxiated full-term neonates and to evaluate the accuracy of an asphyxia morbidity score in predicting acute renal failure. Neonates admitted to one institution from 1990 through 1993 with a gestational age greater than or equal to 36 weeks and 5-min Apgar score less than or equal to 6, without congenital malformations or sepsis, were studied retrospectively for acute renal failure in the Ist week of life. Acute renal failure was defined as serum creatinine >1.5 mg/dl (133 mu mol/l) with normal maternal renal function. Nonoliguric renal failure was defined as renal failure with urine output >1 ml/kg per hour after the Ist day. An asphyxia morbidity scoring system was used to distinguish severe from moderate asphyxia. The score ranged from 0 to 9 and was based upon fetal heart rate, Apgar score at 5 min, and base deficit in the Ist h of life. The score for severe asphyxia was defined as 6-9 and for moderate asphyxia as 1-5. Sixty-six neonates fulfilled study criteria. Acute renal failure was present in 20 of 33 (61%) infants with severe asphyxia scores and 0 of 33 with moderate asphyxia scores (P<0.0001). Acute renal failure was nonoliguric in 12 of 20 (60%), oliguric in 5 of 20 (25%) and anuric in 3 of 20 (15%). In conclusion 1) acute renal failure occurred in 61% of infants with severe asphyxia, 2) acute renal failure associated with severe asphyxia was predominantly nonoliguric and 3) an asphyxia morbidity score, which can be determined at 1 h of age, predicted acute renal failure in full-term infants with 100% sensitivity and 72% specificity.