Role of Renal Ultrasonography in Early Detection of Acute Kidney Injury in Neonates with Sepsis
Keywords:
Neonatal Sepsis, Diagnosis, C-reactive protein, White blood cells, General Urine Examination, Renal Ultrasound, ValidityAbstract
Background: Sepsis, is one of the risk factors for newborn acute kidney injury (AKI). Ultrasonography (US) is the main imaging technique used to assess the renal function problems in newborns due to its benefits of being portable and noninvasive.
Objective: To assess the validity of renal ultrasonography findings in early detection of AKI in neonatal sepsis
Patients and methods: This cross-sectional study was conducted in neonatal intensive care unit in Karbala teaching hospital for children, holly Karbala, Iraq for the period from 3rd of January 2021 to the 31st of December 2021. The study included07 full term neonates with signs and symptoms of sepsis. The results of urinalysis, automated , and C-reactive protein (CRP) were collected and renal ultrasound performed within maximum of 3 days from hospitalization. Validity of ultrasound was assessed based on the validity parameters using standard equation. P. value ≤ 0.05 considered significant.
Results: Compared to GUE, renal ultrasonography showed good sensitivity , specificity , accuracy and negative predictive value (NPV) but low positive predictive value (PPV). Compared to CRP or WBC , renal ultrasonography was low sensitive, specific and accurate. When renal ultrasonography compared to combined WBC and CRP, it showed low sensitivity (33.3%) , low accuracy and very low NPV but 100% specificity and 100% PPV
Conclusion: Renal U/S shows pathological changes in the kidney of some neonate with sepsis. these changes in the U/S can support the diagnosis of sepsis but not to rely on as an independent tool in diagnosis of sepsis alone .
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References
Simonsen KA, Anderson-Berry AL, Delair SF, Davies HD. Early-onset neonatal sepsis. Clin Microbiol Rev. 2014;27(1):21–47.
Hornik CP, Fort P, Clark RH, Watt K, Benjamin Jr DK, Smith PB, et al. Early and late onset sepsis in very-low-birth-weight infants from a large group of neonatal intensive care units. Early Hum Dev. 2012;88:S69–74.
Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med. 2002;347(4):240–7.
Lin TY, Kao HT, Hsieh SH, Huang YC, Chiu CH, Chou YH, et al. Neonatal enterovirus infections: emphasis on risk factors of severe and fatal infections. Pediatr Infect Dis J. 2003;22(10):889–95.
Fleischmann C, Reichert F, Cassini A, Horner R, Harder T, Markwart R, et al. Global incidence and mortality of neonatal sepsis: a systematic review and meta-analysis. Arch Dis Child. 2021;106(8):745–52.
Nyenga AM, Mukuku O, Wembonyama SO. Neonatal sepsis: A review of the literature. Theory Clin Pract Pediatr. 2021;3:94–101.
Rafi MA, Miah MMZ, Wadood MA, Hossain MG. Risk factors and etiology of neonatal sepsis after hospital delivery: A case-control study in a tertiary care hospital of Rajshahi, Bangladesh. PLoS One [Internet]. 2020 Nov 13;15(11):e0242275.
Manandhar S, Amatya P, Ansari I, Joshi N, Maharjan N, Dongol S, et al. Risk factors for the development of neonatal sepsis in a neonatal intensive care unit of a tertiary care hospital of Nepal. BMC Infect Dis [Internet]. 2021;21(1):546.
Adatara P, Afaya A, Salia SM, Afaya RA, Konlan KD, Agyabeng-Fandoh E, et al. Risk factors associated with neonatal sepsis: a case study at a specialist hospital in Ghana. Sci World J. 2019;2019.
Jatsho J, Nishizawa Y, Pelzom D, Sharma R. Clinical and bacteriological profile of neonatal sepsis: a prospective hospital-based study. Int J Pediatr. 2020;2020:1–9.
Li X, Ding X, Shi P, Zhu Y, Huang Y, Li Q, et al. Clinical features and antimicrobial susceptibility profiles of culture-proven neonatal sepsis in a tertiary children’s hospital, 2013 to 2017. Medicine (Baltimore). 2019;98(12).
Cantey JB, Lee JH. Biomarkers for the diagnosis of neonatal sepsis. Clin Perinatol. 2021;48(2):215–27.
Shoukry LR, Mohamed AN, Sharaf AEA, Osman OBS. Diagnostic markers for early detection of neonatal sepsis. J Sci Res Med Biol Sci. 2021;2(3):13–26.
Popescu CR, Cavanagh MMM, Tembo B, Chiume M, Lufesi N, Goldfarb DM, et al. Neonatal sepsis in low-income countries: epidemiology, diagnosis and prevention. Expert Rev Anti Infect Ther. 2020;18(5):443–52.
Ain Ibrahim N, Makmor Bakry M, Mohd Tahir NA, Mohd Zaini NR, Mohamed Shah N. A Prospective Cohort Study of Factors Associated with Empiric Antibiotic De-escalation in Neonates Suspected with Early Onset Sepsis (EOS). Paediatr Drugs. 2020 Jun;22(3):321–30.
Sepsis Alliance, Sepsis Can Cause Kidney Damage - and Vice Versa - [Internet] available at: www.sepsis.org, accessed on April 2023.
Mwamanenge NA, Assenga E, Furia FF. Acute kidney injury among critically ill neonates in a tertiary hospital in Tanzania; Prevalence, risk factors and outcome. PLoS One. 2020;15(2):e0229074.
Jetton JG, Boohaker LJ, Sethi SK, Wazir S, Rohatgi S, Soranno DE, et al. Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. lancet child Adolesc Heal. 2017;1(3):184–94.
Mercado-Deane MG, Beeson JE, John SD. US of renal insufficiency in neonates. Radiographics. 2002;22(6):1429–38.
Yu A, Zhao Q, Qu Y, Liu G. Renal Doppler Ultrasound in the Evaluation of Renal Function in Patients with Sepsis. Appl bionics Biomech. 2022;2022:3472405.
Ratnaparkhi CR, Bayaskar M V, Dhok AP, Bhende V. Utility of Doppler ultrasound in early-onset neonatal sepsis. Indian J Radiol Imaging. 2020;30(1):52–8.
Software Informer, Epicalc 2000, software for Windows. Available at: https://epicalc-2000.software.informer.com/1.0/.
Trevethan R. Sensitivity, Specificity, and Predictive Values: Foundations, Pliabilities, and Pitfalls in Research and Practice. Front public Heal. 2017;5:307.
Coggins SA, Laskin B, Harris MC, Grundmeier RW, Passarella M, McKenna KJ, et al. Acute Kidney Injury Associated with Late-Onset Neonatal Sepsis: A Matched Cohort Study. J Pediatr [Internet]. 2021;231:185-192.e4.
Hisamuddin E, Hisam A, Wahid S, Raza G. Validity of c-reactive protein (CRP) for diagnosis of neonatal sepsis. Pakistan J Med Sci. 2015;31(3):527–31.
Mohseny AB, van Velze V, Steggerda SJ, Smits-Wintjens VEHJ, Bekker V, Lopriore E. Late-onset sepsis due to urinary tract infection in very preterm neonates is not uncommon. Eur J Pediatr. 2018;177:33–8.
Lin DS, Huang SH, Lin CC, Tung YC, Huang TT, Chiu NC, et al. Urinary tract infection in febrile infants younger than eight weeks of age. Pediatrics. 2000;105(2):e20–e20.
Hornik CP, Benjamin DK, Becker KC, Benjamin Jr DK, Li J, Clark RH, et al. Use of the complete blood cell count in early-onset neonatal sepsis. Pediatr Infect Dis J. 2012;31(8):799.
Morag I, Dunn M, Nayot D, Shah PS. Leukocytosis in very low birth weight neonates: associated clinical factors and neonatal outcomes. J Perinatol. 2008;28(10):680–4.
Chacha F, Mirambo MM, Mushi MF, Kayange N, Zuechner A, Kidenya BR, et al. Utility of qualitative C-reactive protein assay and white blood cells counts in the diagnosis of neonatal septicaemia at Bugando Medical Centre, Tanzania. BMC Pediatr. 2014;14(1):1–8.
Sorsa A. Diagnostic significance of white blood cell count and c-reactive protein in neonatal sepsis; Asella Referral Hospital, South East Ethiopia. Open Microbiol J. 2018;12:209.
