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


METHODS
A cohort of ELBW infants was analyzed by Bayley Scales of Infant Development (BSID-II) at the corrected age of 2years 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.
Neonatal Intensive Care Unit, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Pediatric Nephrology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. Electronic address: anke.raaijmakers@uzleuven.be.
Anke
A
Raaijmakers
Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Pediatric Neurology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Els
E
Ortibus
Department of Sociology, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium.
Theun P
TP
van Tienoven
Neonatal Intensive Care Unit, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
Christine
C
Vanhole
Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium; Pediatric Nephrology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Elena
E
Levtchenko
Neonatal Intensive Care Unit, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Herestraat 49, 3000 Leuven, Belgium.
Karel
K
Allegaert
D015415:Biomarkers / Q000097:blood*; D002657:Child Development / Q000502:physiology*; D016000:Cluster Analysis; D003071:Cognition / Q000502:physiology*; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood*; D006801:Humans; D052577:Infant, Extremely Low Birth Weight / Q000097:blood* / Q000502:physiology*; D007231:Infant, Newborn; D008833:Microcirculation / Q000502:physiology*; D018709:Statistics, Nonparametric
D015415:Biomarkers; D003404:Creatinine
Bayley Scales of Infant Development (BSID); Biomarker; Long term outcome; Optimal matching