To study renal parameters and serum calcium levels in birth asphyxia

To study renal parameters and serum calcium levels in birth asphyxia Patidar A.1, Chandra Mandliya J.2*, Sonker P.3, Dhaneria M.4 DOI: https://doi.org/10.17511/ijpr.2020.i06.06 1 Amit Patidar, PG Resident, Department of Pediatrics, R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India. 2* Jagdish Chandra Mandliya, Professor, Department of Pediatrics, R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India. 3 Pavan Sonker, Professor, Department of Biochemistry, R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India. 4 Mamta Dhaneria, Head of Department and Professor, Department of Pediatrics, R.D. Gardi Medical College, Ujjain, Madhya Pradesh, India.


Introduction
The incidence of perinatal asphyxia is 1-1.5 % in most developed countries and is inversely related to gestational age and birth weight [1]. In India the incidence of perinatal hypoxia is as high as 8 -9% and it accounts for 28.8% of neonatal deaths and 45.1% of fresh still births [2].
According to the latest estimates by World Health Organization (WHO), approximately 4 million babies die each year before they reach the age of one month, ninety eight percent of these neonatal deaths take place in the developing countries.  Acute renal failure was defined as serum creatinine of >1.0mg/dl on day 3 of life or urine output <1.0ml/kg/hr. Hypocalcemia in the present study was defined as serum calcium level<8.0mg/dl On the basis of Apgar score at 1minute asphyxiated babies grouped into mild (6) moderate (4-5) and Severe asphyxia ≤3 Apgar Score  The study included 69 cases and 69 controls with the majority of boys in both groups. There were 48boys among cases and 44 boys among controls The study population includes the majority of neonates with moderate and severe birth asphyxia accounting for 29% and64% of all cases respectively. Mild asphyxia accounting for 7%  Incidence of acute renal failure was 57% among cases which were statistically significant (P=0.000)   The study showed serum calcium levels were low among cases.  Incidence of hypocalcemia was 58% in cases with birth asphyxia and 2% in control The present study noted that boys were more common in cases and control both. It includes 70% boys among cases and 64% of boys among the control group out of 69 in each case and controls separately. In the study done by Mac Donald [10] and others, the incidence of asphyxia was 54% in Male babies and 46% in female babies which correlated well with the present study.
Ganavi et al and colleague (2016) concluded that the incidence of acute renal failure was significantly more in cases (75% vs 4%) and 18.4 times more likely when compared to controls.
In the present study, the incidence of acute renal failure was 57% among cases. The incidence of acute renal failure among cases (P=0.000) is statistically significant [9,11].
In the present study, the incidence of renal failure was comparable with the studies done by Gupta et al [12], Zulfikar Ali Mangi et al [13], Aggarwal et al [14] and Jayashree et al [15].
In the current study serum creatinine of more than 1 mg/dl after 72 hours was considered as renal failure. All studies showed that non-oliguric renal failure was most common in asphyxiated neonates.

Conclusion
The following conclusion was made in the present study: What does the study add to the existing knowledge?
The renal indices should be calculated, as fractional excretion of sodium is preferred to classify the renal failure into pre-renal or intrinsic renal failure as management differs for both entities. Acute renal failure in birth asphyxia shows a strong positive correlation with HIE. In Hypoxic Ischemic Encephalopathy prevention intrinsic renal failure is Better than managing as it is associated with multiorgan dysfunction syndrome and has increased mortality.  [Crossref] 02. Ilah BG, Aminu MS, Musa A, Adelakun MB, Adeniji AO, Kolawole T. Prevalence and risk factors for perinatal asphyxia as seen at a specialist hospital in Gusau, Nigeria. Sub-Saharan Af J Med. 2015;2(2)64. [Crossref] 03. World Health Organization. Perinatal mortality-a listing of available information. World Health Organization. 1996. [Crossref] 04. Network NN. National Neonatal Perinatal Database-report for the year 2002-2003. NNF NNPD network; New Delhi. 2005. [Crossref] 05. Agarwal R, Jain A, Deorari AK, Paul VK. Postresuscitation management of asphyxiated neonates. Indian J Pediatr. 2008;75(2)175-180. [Crossref] 06. Lawn J, Shibuya K, Stein C.  [Crossref] Pediatric Review -International Journal of Pediatric Research 2020;7(6) 260