Neonatal creatinemia trends as biomarker of subsequent cognitive outcome in extremely low birth weight neonates

• Published in: Early human development Vol. 91; no. 6; pp. 367 - 372
• Main Authors: Raaijmakers, Anke, Ortibus, Els, van Tienoven, Theun P, Vanhole, Christine, Levtchenko, Elena, Allegaert, Karel
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier Ireland Ltd 01.06.2015
• Subjects: Advanced Basic Science; Bayley Scales of Infant Development (BSID); Biomarker; Biomarkers - blood; Child Development - physiology; Cluster Analysis; Cognition - physiology; Cohort Studies; Creatinine - blood; Humans; Infant, Extremely Low Birth Weight - blood; Infant, Extremely Low Birth Weight - physiology; Infant, Newborn; Long term outcome; Microcirculation - physiology; Neonatal and Perinatal Medicine; Optimal matching; Statistics, Nonparametric; Biomarker; (e)GFR; Scr; Mental Developmental Index; serum creatinine; Psychomotor Developmental Index; BSID; MDI; extremely low birth weight; intraventricular hemorrhage; PDI; Bayley Scales of Infant Development; Long term outcome; (estimated) glomerular filtration rate; Bayley Scales of Infant Development (BSID); acute kidney injury; IVH; ELBW; Optimal matching; AKI
• ISSN: 0378-3782; 1872-6232
• DOI: 10.1016/j.earlhumdev.2015.03.008

Abstract Background and aims Serum creatinine is traditionally used as a marker of renal function in neonates and relates to gestational age and disease severity in extremely low birth weight (ELBW) infants. Creatinine is commonly used as a biomarker for early morbidity, but we aim to compare postnatal creatinemia trends as a biomarker for subsequent cognitive outcome. We hypothesize that impaired microcirculation not only in the kidney, but also in general (i.e. brain development) can explain this possible link. Study design and outcome measures A cohort of ELBW infants was analyzed by Bayley Scales of Infant Development (BSID-II) at the corrected age of 2 years old. Besides other perinatal indicators, neonatal creatinemia trends of survivors (n = 140) and BSID scores (n = 96) are compared and analyzed using optimal matching analysis. Hierarchical clustering analysis is applied to identify createnimia trends. Results Four different creatinemia trends were identified (persistently high, normal, low, high but normalizing). A low creatinemia trend is significantly associated with the lowest percentages of postnatal corticosteroids, NSAIDS and intraventricular hemorrhage (p = 0.005, p = 0.013 and p = 0.041 respectively) compared to a normal or persistently high creatinemia trend and associated with the best cognitive outcome (+ 13 points compared to the mean creatinemia trend and + 23 points compared to a persistently high creatinemia trend). Conclusions Creatinemia trends after birth are not only useful to predict renal function, but are also associated with cognitive outcome in extremely low birth weight infants. Neonates who have low creatinemia trends after birth, have the highest BSID scores at the age of two years old.