The Application Value Of Urinary NGAL In Neonatal Asphyxia With Acute Kidney Injury

Objective Neonatal Asphyxia(Neonatal Asphyxia,NA)is a common disease of the newborn,can lead to different levels of organ damage,including kidney damage which is the most common.Currently,clinical diagnosis of newborns with acute kidney injury(AKI)is based on the level of serum creatinine(Scr),urea nitrogen(BUN),or urine volume.However,the impact factors of these indicators is more.And their sensitivity and specificity is poor,which can’t reflect the real damage on kidney synchronously.So funding a new marker for early monitoring of kidney injury in newborn babies is very necessary.In recent years,neutrophil gelatinase-associated lipocalin(NGAL)as a new,timely and reliable operation of the early renal damage biological markers has gotten a lot of attention.But the reports of NGAL on clinical application in newborn are very lack.How to using NGAL as a biological marker applied to the validation and application of neonatal AKI clinical practice,has great significance for improving the prognosis of neonatal of AKI.This study will detect the expression level of urine NGAL(u NGAL)in suffocation full-term newborns,and discuss its clinical value in diagnosis of acute kidney injury after neonatal asphyxia,in order to make timely diagnosis and treatment of renal injury after neonatal asphyxia,and improve the prognosis of neonatal asphyxia.Methods 1.The diagnosis of neonatal asphyxia is based on the diagnostic criteria established by the neonatal resuscitation group of the Chinese medical association in 2016.The diagnosis of neonatal acute kidney injury is based on the diagnostic criteria established by AKIN in 2005.AKI staging was based on the children’s RIFLE staging standard(p RIFLE)proposed by the international pediatric nephrology group in 2007.2.Choose 114 full-term newborns with perinatal asphyxia hospitalized in pediatrics of Tian Jin Children’s hospital in September 2016-September 2017.According to AKI within 1 week after birth is occurring,39 cases were divided into AKI group and 75 cases into the group not with AKI.Thirty-three healthy children in the same period were randomly selected as healthy control group.3.The level of neonatal urine NGAL was detected by using latex enhanced immunotransmittance turbidimetry in neonatal asphyxia and healthy control group.The urine creatinine(Ucr),serum creatinine(Scr)and urea nitrogen(BUN)levels were also measured at the same time.4.Use the statistical software SPSS19.0 for analysis.Normal distribution statistics was describedby using the mean standard anddeviation(sx ±).And the comparison between the two groups using t-test,while the multigroup comparisonusedby analysis of variance.Abnormal distribution statistics was described by the median±interquartile range(M±Q).And the comparison between groups using rank and inspection.The statistical description of counting data was used as the composition ratio,and the chi-square test was adopted for comparison between groups.P ﹤ 0.05 was considered to be statistically significant.By drawing the Receiver Operating Characteristic Curve(ROC)and calculating the Area Under the Calculated Curve(AUC),the diagnostic effect of urinary NGAL to asphyxiated neonatal AKI was evaluated.Results 1.A total of 114 cases of perinatal asphyxia full-term newborns from September 2016 to September 2017 were enrolled in this study.The mild asphyxia group had 88 patients,the severe asphyxia group had 26 patients and the control group had 33 patients.The gender,gestational age,birth weight and body length of the three groups were not statistically significant.1 day after the birth,the level of blood Scr,BUN between mild asphyxia group and severe asphyxia,or between the mild asphyxia group and healthy control group,or between the severe asphyxia group and health control group had no statistical significance(P > 0.05).1 day after the birth,the level of urine NGAL between deffrent asphyxia group and healthy control group,had statistical significance(P < 0.05).And the level of urine NGAL increased gradually with the degree of asphyxia aggravating.2.A total of 114 infants were enrolled in term of term,of which 39 were associated with AKI,with a rate of 34.2%.The incidence of AKI of mild asphyxia group was 27.2%(24/88).And the incidence of severe asphyxia AKI group was 57.69%(15/26).The difference between these two groups was statistically significant.3.The differences of gender,gestational age,birth,birth weight,body length and 1 min Apgar score with asphyxia newborn children AKI group and non AKI had no statistical significance(P > 0.05).But the 5 min Apgar score in AKI group was below the non AKI group,and the difference has statistically significance(P < 0.05).4.There were statistically significant differences between the AKI group and the non AKI group on the level of urinary NGAL and NGAL/ urinary creatinine in the first and third day after the birth(P<0.05).There was no statistically significant difference in serum creatinine(P>0.05)between AKI group and non-AKI group in the first day after birth.But the difference in serum creatinine was statistically significant(P<0.05)in the second and third day after birth.5.The difference of the level NGAL between the first day and the third day after birth was statistically significant,which increasing gradually with the increase of AKI.The level of urinary NGAL increased gradually with the increase of AKI,and was positively correlated with serum creatinine level.6.The ROC curve of AKI in asphyxia neonatorum diagnosed by NGAL after first days of birth was plotted.The area under ROC curve(AUC)was 0.842(95%CI:0.770~0.915),P=0.000.The sensitivity of the diagnosis of AKI was 87.2%,while the specificity was 94.7%.The positive predictive value and negative predictive value were 89.5%,94.3%.And the diagnosis point was 118ng/ml.Conclusions 1.The level of urine NGAL maybe a objective diagnosis and judgment predictors as neonatal asphyxia severity.2.The possibility of the organ damage maybe increasing with the degree of the asphyxia degree.3.The 5 min Apgar score has a strong correlation with the prognosis.Timely and effective resuscitation can reduce the incidence of AKI after asphyxia.4.u NGAL is a sensitive and specific index for early diagnosis of AKI in asphyxia neonatorum,which is significantly higher than the blood creatinine for at least 1 days in advance,and it has the advantages of noninvasive,easy to measure and repeatable..5.The level of u NGAL can reflect the severity of renal impairment.6.The results of ROC curve analysis suggest that urinary NGAL has a high diagnostic value for AKI in asphyxia neonates.When the cutoff value is 118 ng/ml,the sensitivity of the diagnosis is 87.2% and the specificity is 94.7%.