Effect of Septicaemia on Renal Performance in the Neonate

Acute Renal Failure (ARF) and renal impairment may result from insults to the otherwise normal neonatal kidneys in the postnatal period. Neonatal septicaemia is associated with multiorgan dysfunction and is a leading cause for the occurrence of acute renal failure in such infants. Aim of the Study: Is to assess the occurrence of ARF complicating neonatal sepsis and effect of associated contributing factors. Patients and Methods: Over a period of 12 months at the neonatal department of Al Galaa teaching hospital, out of 250 studied cases with neonatal sepsis, ARF complicated 79 (31.6%) of neonates. All cases were assessed for gestational age, birth-weight, sex, AS, and other co-morbidities: nephrotoxic drugs, DIC, shock, maternal drug intake and mechanical ventilation. A full sepsis screen and evaluation of renal functions by estimating the urine output, BUN and Pcr was carried out for all studied babies. ARF was diagnosed if Pcr 1.5mg/dl adjusted for gestational and postnatal age, with or without oliguria, with or without increased BUN 20mg/dl., on two separate occasions 24 hours apart. Results: Majority of cases of ARF complicating neonatal sepsis were preterm babies between 32-36 weeks gestation, 35 cases (44.3%). Oliguric ARF was found in 16.5% of cases. The mortality rate was 72.2% (57 cases) in ARF compared to 26.3% (45 cases) in sepsis without ARF (p 0.001). Acute renal failure was significantly higher in low-birth-weight (LBW) and extremely low-birth-weight (ELBW) neonates of same gestational age group without ARF (87.4% 30.3% Vs 65.5% 17%, p 0.01 p 0.001 respectively). DIC and shock were significantly higher in ARF complicating neonatal sepsis (p 0.05, p 0.001). Perinatal asphyxia, mechanical ventilation and nephrotoxic drugs did not significantly increase the occurrence of ARF in septic neonates. Recovery from ARF occurred in 43 (54.4%) cases. Conclusion: ARF complicating neonatal sepsis occurred in 31.6% of our study cases. It was significantly increased in, the lower birth-weight and gestational age neonates, DIC and shock.