Akademik Veri Yönetim Sistemi
Pediatric Nephrology, 2025 (SCI-Expanded)
Background: Acute kidney injury (AKI) is an important complication in neonates with hypoxic ischemic encephalopathy (HIE). The aim was to assess the association between early lactate elimination trend and development of AKI in neonates with HIE receiving therapeutic hypothermia. Methods: Medical records of 257 neonates with moderate-severe HIE were retrospectively analyzed for development of AKI based on neonatal Kidney Disease Improving Global Outcomes (KDIGO) criteria. Blood lactate values over time for the first 5 days were recorded. The percentage decrease in lactate values was calculated during the first 12 h and on a daily basis and reported as lactate elimination trend. Logistic regression analysis and receiver operating characteristics curve (ROC) analysis were conducted. Results: AKI developed in 70 neonates (27.2%). Median initial and 12-h lactate values were significantly higher in the AKI group. Lactate elimination trend at 12-h was significantly lower in the AKI group compared to neonates with no AKI (43.6% vs 61.4%, p < 0.001). Lower 12-h lactate elimination trend was associated with development of AKI (OR: 21.27, 95%CI: 6.73–67.17, p < 0.001). ROC curve analysis demonstrated a 47.5% decrease in lactate values at 12-h as critical cut-off value of lactate elimination trend with 90% specificity and 64% sensitivity to predict AKI. Area under curve was found to be 0.813 (95% CI: 0.76–0.86, p < 0.001). Conclusions: Lactate elimination trend in the first 12 h can be used as an early marker for AKI in neonates with HIE receiving therapeutic hypothermia. The presence of decreased lactate elimination trend will allow for careful fluid management and early medical interventions in this highly vulnerable patient population.