Renal follow up of premature infants with and without perinatal indomethacin exposure

R Ojalaa, M Ala-Houhalaa, S Ahonenb, A Harmoinenc, V Turjanmaad, S Ikonena, O Tammelaa

a Department of Paediatrics, Tampere University Hospital, PO Box 2000, FIN 33521, Tampere, Finland, b Department of Radiology, Tampere University Hospital, c Department of Clinical Chemistry, Tampere University Hospital, d Department of Clinical Physiology, Tampere University Hospital

AIMS To evaluate early childhood renal growth, structure, and function in children born at less than 33 weeks gestation and to investigate possible independent effects of perinatal indomethacin exposure. METHODS A total of 66 children born at less than 33 weeks gestation, 31 of them with perinatal indomethacin exposure (study group) and 35 without (control group), were examined at 2-4 years of age. Serum cystatin C and protein; plasma creatinine, sodium, and potassium; urine protein, calcium:creatinine ratios, and 1 microglobulin; and glomerular filtration rate (GFR) were determined. Renal sonography examinations were performed. The mean serum cystatin C concentrations were slightly higher in the control group than in the study group. Mean values of serum protein, and plasma creatinine and sodium did not differ between the groups, neither did median plasma potassium concentrations and urine protein:creatinine and calcium:creatinine ratios. None had tubular proteinuria. Abnormal GFR (<89 ml/min/1.73 m2) was found in one case in each group and renal structural abnormalities in five in each group. In logistic regression analysis the duration of umbilical artery catheter (UAC) use and furosemide treatment emerged as the significant independent risk factors for renal structural abnormalities. Furosemide treatment and assisted ventilation remained the risk factors associated with renal abnormalities in generalthat is, functional and/or structural abnormal findings. CONCLUSION Perinatal indomethacin does not seem to affect long term renal growth, structure, or function in children born at less than 33 weeks gestation. Duration of UAC use, furosemide treatment, and assisted ventilation may be correlated with later renal structural and functional abnormalities.

Arch Dis Child Fetal Neonatal Ed 2001;84:F28-F33