Comparative Analysis of Renal Function Status between Term and Preterm Neonates: Implications for Clinical Care

Abstract

Introduction: Neonatal renal function is a critical determinant of early health outcomes, especially in preterm neonates whose nephrogenesis may be incomplete at birth. Acute kidney injury (AKI) contributes significantly to neonatal morbidity and mortality worldwide, yet remains underdiagnosed, particularly in resource-limited settings like Bangladesh. Aim of the Study: The study aimed to conduct a comparative analysis of renal function status in term versus preterm neonates to evaluate implications for clinical care. Methods: This hospital-based comparative cross-sectional study was conducted at Dhaka Shishu Hospital, Bangladesh over a period of six months, from May to November 2024. Fifty neonates (25 term ≥37 weeks and 25 preterm <37 weeks) were enrolled consecutively. Serum creatinine, urea, sodium, potassium, calcium, and phosphorus were measured at 24 hours and 7 days of life. AKI was defined according to modified neonatal KDIGO criteria. Statistical analysis included t-tests, chi-square tests, and logistic regression; p<0.05 was considered significant. Results: Among the 50 neonates studied, preterm neonates had significantly lower birth weights (1.78±0.35 kg) than term neonates (2.77±0.41 kg; p<0.001). Cesarean section was the predominant mode of delivery overall (80.0%), more common in preterms (88.0%) than terms (72.0%; p=0.028) Cesarean delivery was the predominant mode overall (80.0%), being more common in preterm (88.0%) than term neonates (72.0%; p=0.028). Male neonates predominated in both groups, though not statistically significant. Preterm neonates had higher serum creatinine at 24 hours (0.82±0.31 vs. 0.68±0.24 mg/dL; p=0.041) and 7 days (0.71±0.28 vs. 0.52±0.19 mg/dL; p=0.003). Blood urea at 7 days was also elevated in preterms (31.2±14.7 vs. 22.8±9.4 mg/dL; p=0.014). Reduced urine output was more common in preterms at 24 hours (40.0% vs. 12.0%; p=0.008) and 7 days (24.0% vs. 4.0%; p=0.023). AKI prevalence was significantly higher in preterms (48.0%) than in term neonates (16.0%; p=0.013). Preterm birth was an independent predictor of AKI (adjusted OR=4.12; p=0.038). Conclusion: Preterm neonates demonstrated significantly higher rates of AKI and impaired renal function compared to term neonates, underscoring the need for routine renal function monitoring and early intervention in this high-risk population.