Renal injury and hypocalcaemia in newborns with birth asphyxia at a tertiary care centre: a prospective observational study.

BACKGROUND

Birth asphyxia, also known as perinatal hypoxia-ischaemia, is a significant cause of neonatal morbidity and mortality. It occurs when a newborn experiences insufficient oxygen during birth, potentially leading to multisystem injury including renal dysfunction and disruption of calcium homeostasis. Understanding the impact of birth asphyxia on renal function and serum calcium levels is critical for early detection and timely intervention.

MATERIALS AND

METHODS

Of 185 term neonates assessed for eligibility (27 excluded-congenital anomalies n=10; septicemia n=9; respiratory distress syndrome n=8; see flow chart), a total of 158 term neonates with birth asphyxia were enrolled. Renal function parameters (serum creatinine, serum urea) and serum calcium levels were measured at admission (within 2 hours of birth), at approximately 48±4 hours and at approximately 72±4 hours of life. All samples were analysed on a Beckman Coulter AU480 automated analyser by a blinded technician. Data were analysed in SPSS V.25 (IBM); descriptive tests included independent-samples t-tests (or Mann-Whitney U for non-normal data) and χ² tests as appropriate and multivariate logistic regression was used to adjust for potential confounders; there were no missing data. Acute kidney injury (AKI) was defined using modified neonatal KDIGO (kidney disease: improving global outcomes) criteria based on serum creatinine values and urine output, and hypocalcaemia was defined as serum calcium <8.0 mg/dL.

RESULTS

AKI was observed in 88/158 (55.7%) neonates and hypocalcaemia in 92/158 (58.2%). Elevated serum creatinine was noted in 110/158 (69.6%) and elevated urea in 104/158 (65.8%) neonates. These abnormalities were more common in neonates with severe asphyxia. Serum creatinine and urea levels peaked at 48 hours, while serum calcium levels declined significantly within the first 48 hours, particularly in severe cases.

CONCLUSION

A high incidence of AKI and hypocalcaemia was found in neonates with birth asphyxia. These findings highlight the importance of routine biochemical monitoring and early intervention to mitigate complications and improve neonatal outcomes.