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Original article

Paediatrica IndonesianaPaediatr Indones 2001; 41:175-179

The effect of neonatal asphyxia on renal function

Ellya Nova Lubis, Srie Yanda, Khainir Akbar, Guslihan Dasa Ti!ta, Dachrul Aldy

De!art"ent o# $hild %ealth, &edical School 'niversity o# North Su"atera ( %) Ada" &alik %os!ital, &edan

 ABSTRACT Neonatal as!hy*ia can cause renal !er#usion and dilution disorders and also glo"erular #iltration

abnor"ality) The !ur!ose o# this study +as to #ind renal dys#unction, +hich caused by neonatal as!hy*ia) The study +as

!er#or"ed by cross sectional #or ne+born babies +ith as!hy*ia based on A!gar score in the #irst "inute) Ne+born babies

+ithout as!hy*ia +ere as control) n both grou!, the #irst "icturition ti"es +ere recorded, total urine out!ut in -. hours +erecounted, the "ean o# blood urea and creatinine seru" level value e*a"ined and also glo"erular #iltration rate) Statistical

analysis has been !er#or"ed by using /isher E*act test, Student t test and 0ilco*on 1ank Su" test) All o# babies in the

as!hy*iated and non as!hy*iated grou! had the #irst "icturition in -. hours a#ter delivery) Signi#icant di##erence o# oliguria

incidence +as #ound in the as!hy*iated grou! co"!ared to the control grou! 2!34,456) The "ean o# blood urea and

creatinine seru" level +as signi#icantly higher in as!hy*iated 2!34,456) The "ean o# glo"erular #iltration rate in the

as!hy*iated grou! +as not signi#i7 cantly di##erent to the control grou! 2!84,456) According to the degree o# as!hy*ia +e

#ound signi#icantly di##erent o# renal dys#unction 2!34,456) t +as concluded that the as!hy*ia could cause the

occurrence o# renal dys#unction) [Paediatr Indones 2001; 41:175-17!

Keywords9 neonatal as!hy*ia, renal #unction, A!gar scores)

I N  NEONATES, HPO!IA AN" IS#HE$IA $A O##%& ASres'(t o) *ario's a+nora(ities or erinata( diseases.

T/e ost coon a+nora(it /ic/ res'(t in

/oia and isc/eia is neonata( as/ia.1  Neonata(

as/ia i(( occ'r i) a +a+ /as 3as ec/an3e and

o3en transortation disorders at +irt/ t/en res'(t

(ac o) o3en s'( and di))ic'(ties in

car+ondioide eiration. In t/is condition, t/e

 +a+ 's'a(( can not resire sontaneo's( and

re3'(ar( soon a)ter +irt/.2,,4

In t/e initia( sta3e, /oia and isc/eia rocess

rise reaction o) ssteic circ'(ator adatation.

"orreespondence9 Ellya Nova Lubis, &)D), De!art"ent o# $hild

%ealth, &edical School 'niversity o# North Su"atera ( %) Ada"

&alik %os!ital, &edan :alan ;unga Lau No) hone9 24?

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'+is et a(.: E))ect o) neonata( as/ia on rena( )'nction 178178 Paediatrica Indonesiana ;o(. 41 No. 7-, 8? Assessent o) rena(

0, 45× )'nction 'sed )or'(a :14,15 @& B

#ethods

T/is cross sectiona( st'd as er)ored in

Perinato(o3 S'+ "i*ision "eartent o) #/i(d

Hea(t/, $edica( Sc/oo(, %ni*ersit o)  Nort/

S'atera, H. Ada $a(i Hosita( in $edan )roOcto+er 199 to 1? ne+orn  +a+ies it/

con3enita( /eart disease /ic/ deterined + *irt'e

o) c(inica( )eat'res, >2? ne- +orn +a+ies /o /ad

not ict'rition it/in 4 /o'rs, ro*ed + %S@

eaination to )ind 'ro3enita( a+nor - a(ities, >?

'nco(eted e2aination.

T/e e*a('ated A3ar score in )irst in'te to

deterine de3ree o) as/ia as done + t/e a't/or 

or residents in Pediatrics, "eartent o) #/i(d

Hea(t/, $edica( Sc/oo(, %ni*ersit o)  Nort/

S'atera. T/e de3rees o) as/ia i3/t +e di*ided

on: >1? Nora( >it/o't as/ia?, A3ar score o) 7

to 10; >2? $i(d-oderate as/ia, A3ar score o) 4

to 8; >? se*ere as/ia, A3ar score o) 0 to .

In as/iated and non as/iated 3ro' e

did eas'reent o): >1? +od ei3/t and +od

(en3t/, >2? /sica( eaination, >? recordin3 o) 

)irst 'rina- tion tie a)ter +irt/, >4? 'rine o't't

as co((ected d'rin3 24 /o'rs a)ter +irt/. or a(e

 +a+ies, t/e co(- (ectin3 'rine 'sed (astic +a3,

/ereas )or )ea(e +a- +ies , it 'sed ediatric 'rine

secien co((ector >%ro3rad? ade in Ter'o

#ororation Too. T/e 'rine o't't as eas'red + eas'rin3 3(ass. >5?

S#r 

@&: 3(oer'(ar )i(tration rate >(=in'te=

1,72?, Nora( @& in ne+orn : 20 to 25

(=in'te=

1,72 >20C o) @& in ad'(ts?14, : +od (en3t/

>c?, S#r

: (e*e( o) creatinine ser' >3=d(?, 0,45 :

eiric constanta )or aroriate )or 3estationa( a3e

 +a+ies.

T/e oerationa( de)inition ere: >1? O(i3'ria

as de)ined as 'rinar ecretion (ess t/an 1 (=3

 +od ei3/t=/o'rs.2 >2? T/ere as rena( ds)'nction

i) @& (ess t/an 20 (=in'te=1,7 2. >?

@estationa( a3e as deterined )irst da in t/e (ast

enstr'a( sic(e.

"ata ere ta+'(ated and ana(Ded + 'sin3

co- 'ter. #orre(ation +eteen to 'a(itati*e

data as tested + #/i-S'are test, i) )o'nd

eected *a('e (ess t/an 5 'sed is/er Eact test.To e*a('ate t/e corre(ation +eteen to 'antitati*e

data as tested + t-test, i) )o'nd etree *a('e and

a+nora( distri- +'tion, 'sed 6i(coon &an S'

test. T/e (e*e( o) si3ni)icance as F0,05.

$esults

T/e st'd as cond'cted )ro Octo+er 199 to8 aon3 t/e ere se*ere

as/ia?, /i(e 80 ot/er +a+ies ere not as/ia.A(( o) +a+ies in as/iated and non-

as/iated 3ro' /ad ict'rition in 24 /o'rs o) (i)e.

T/irt-ei3/t +a+ies >84C? o) t/e as/iated 3ro'

and 44 +a+ies >7C? o) non-as/iated 3ro' /ad

ict'rition /o'rs a)ter +irt/ >Ta+(e 1?.

In t/e as/iated 3ro', t/ere ere si +a+ies

>10C? /ad o(i3'ria /ereas in t/e non-as/iated

3ro' as none. 6e )o'nd statistica(( si3ni)icant

di))erence it/ F0,05 >Ta+(e 2?. T/e ean creati-

nine ser' (e*e( in as/iated 3ro' as 0,00

G0,2922 3=d(, si3ni)icant( di))erent it/ non

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T%&'( 1) T*( TI#( +, ,I$T #I"T.$ITI+/ I/ &+T*

%P*I%T( %/ /+/-%P*I%T( 3$+.P

Grou! 4 7 @ hrs 8@7-. hrs Total

T%&(' ) $('%TI+/ &(T((/ %P*I% (3$(( IT*

$(/%' ,./"TI+/

Total @- =

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ds)'nction.19,20 or )'rt/er c(ari)ication, it is neces-

sar to er)or +(ood 'rea and creatinine ser' (e*e(

to deterine t/e occ'rance o) rena( )ai('re.14,15 In

t/is st'd, o(i3'ria as )o'nd in 8 +a+ies >10C?

)ro as/iated 3ro' >Ta+(e 2?, /ic/ )i*e +a+ies

it/ se*ere as/ia and one  +a+ies as oderate

as/ia.

T/e ain rena( )'nction is to c(ean t/e (asa

)ro 'nnecessar a3ents )or /'an +od, artic'(ar(

 rotein eta+o(ic o't't. #reatinine ser' and +(ood

'rea are to +(ood c/eica( a3ents /ic/ in nora(

condition is ecreted t/ro'3/ idne. I) t/e disor-

ders occ'r in ne/ron d'e to /oer)'sion or /-

 oia, t/ere)ore, c(earance o) t/ose to a3ents i((

decrease and t/eir (e*e(s i(( increase in t/e +(ood.

#reatinine ser' is sti(( a re(ia+(e indicator to e*a('-

ate ne+orn rena( )'nction.17 In t/is st'd e )o'nd

si3ni)icant( di))erent in ean creatinine ser' and

 +(ood 'rea (e*e(, /ic/ as/iated 3ro' as /i3/er coare it/ non as/iated 3ro' >Ta+(e ,4?.

A(t/o'3/ ean creatinine ser' and +(ood 'rea (e*e(

in as/iated 3ro' ere /i3/er coare to non as-

 /iated 3ro', +'t t/e *a('e in +ot/ 3ro' as in

nora( (iit. I) e ec('ded se*ere as/ia in as-

 /iated 3ro', ean creatinine ser' and +(ood

'rea (e*e( in i(d-oderate as/ia ere 0,7810 G

0,2922 3=d( and t/is *a('e is in nora( (iit, /i(e

ean creatinine ser' and +(ood 'rea (e*e( in se*ere

as/ia ere 1,451 G 0,225 3=d(. $ean creati-

nine ser' (e*e( in se*ere as/ia as /i3/er co-

 ared to nora( *a('e. In $aardiKs st'd, t/e )o'nd

ean creatinine ser' and +(ood 'rea (e*e( in st'd

3ro' >as/ia +a+ and resirator sndroe?, not

si3ni)icant( di))erent coare it/ contro( 3ro'.17

In t/e as/iated ne+orn +a+ies @& ere co-

on( (oer t/an ne+orn 3(oer'(ar )i(tration rate

o) t/e non-as/iated 3ro' +'t it/ t/e sae

3esta- tiona( a3e. In t/at condition, decreased

@& as stron3( re(ated to t/e se*erit o) 

as/ia.14 In t/is st'd e did not )ind di))erences

o) ean @& in as- /iated and non as/iated

3ro' >Ta+(e 5?. In i(d and oderate 3ro', a(( +a+ies /a*e nora( @& *a('e, sii(ar it/ non-

as/iated 3ro', /i(e in se*ere as/ia 3ro',

e )o'nd (o @& *a('e in C >5 )ro 8 +a+ies?.

6e )o'nd si3ni)icant( di))erent ac- cordin3 to

incidence. o @& o) se*ere as/ia as coared

to i(d-oderate in t/is st'd >Ta+(e 8?.

T/e aJor c/aracteristic o) ac'te rena( )ai('re

as aDoteia it/ or it/o't o(i3'ria.20,21 #/ronic

rena(

)ai('re as esta+(is/ed +ase on 'rine o't't (ess t/an

1 (=3 6=/o'r it/ creatinine ser' (e*e( ore

t/an

1,5 3=d( in 2 'nti( 5 das o) (i)e. In ac'te rena(

)ai('re non o(i3'ric e )o'nd nora( 'rine or ore

and crea- tinine ser' (e*e( as /i3/.14 ar(oicD and

Ade(an reorted t/at ac'te rena( )ai('re as )o'nd

in 81C o) se*ere as/ia +a+, /ic/ ac'te rena(

)ai('re as esta+(is/ed as creatinine ser' (e*e( ore

t/an 1,5 3= d(.22 "a'+er reorted t/at in se*en

as/ia +a+ies, t/ree o) t/e /a*e rena( )ai('re >G

40C?.11 In t/is st'd, creatinine ser' (e*e( as

assessed in to das o) (i)e. In i(d and oderate

as/iated +a+ies, e did not )ind rena( ds)'nction,

/i(e in se*ere as/i- ated +a+ies associated it/

ac'te rena( )ai('re, e )o'nd o(i3'ria and to )ro

si +a+ies /o /ad o(i3- 'ria 3ot rena( )ai('re and

t/e +ot/ died.

In s'ar, a(( o) +a+ies in +ot/ 3ro's /adic- t'rition d'rin3 t/e )irst 24 /o'rs a)ter +irt/.

T/ere as si3ni)icant di))erence +eteen +a+ies /o

/ad o(i3'ria in t/e as/iated 3ro' and non-

as/iated 3ro'. T/e ean creatinine ser' and

 +(ood 'rea (e*e( as si3ni)icant( di))erent +eteen

as/iated and non- as/iated 3ro'. T/e ean

@& *a('e did not si3- ni)icant( di))erent aon3

as/iated 3ro' and non as/iated 3ro'.

6/i(e +ased on as/iated de- 3ree, t/ere as

corre(ation +eteen t/e se*erit o) as- /ia it/

rena( ds)'nction. Accordin3 to dia3noses o) o(i3'ric

rena( )ai('re e )o'nd rena( )ai('re in C >to o) 

si +a+ies it/ se*ere as/iated?.

$eferences

1. Ain'((a/ A. onse'ensi e(ainan sistei +er+a3ai

or- 3an t'+'/ ai+at /iosia dan iseia neonat's. In:

S'radi &, $onintJa HE, Aa(ia P, 's'oard/ani ",

editors. Penan3anan 'ta/ir  +ai  reat'r: een'/i

 e+'t'/an  +ai reat'r 'nt' en'nJan3

 enin3atan 'a(itas s'+er daa an'sia.  Nasa/

(en3a P IA !!!III

- %I.

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5. Indarso . "aa Jan3a anJan3 +ai as)isia.Presented

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at t/e !I #on3ress o) t/e Indonesian Pediatrician

Societ,