Infants with severe kidney disease experience high risk for early growth failure
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Infants with severe congenital anomalies of the kidney and urinary tract, including those who do not require dialysis, are at risk for early growth failure, according to data published in the Journal of Renal Nutrition.
Further, researchers wrote that delays in enteral nutrition may be a contributor to the “profound” growth failure, especially during the first 2 months of life.
“Growth represents a state of well-being, and growth impairment can occur due to insufficient nutrient provision or due to increased demands,” Cara L. Slagle, MD, from the division of neonatology and pulmonary biology at Cincinnati Children’s Hospital Medical Center and the department of pediatrics at the University of Cincinnati College of Medicine, and colleagues wrote. “We found that infants with significant [chronic kidney disease] CKD due to congenital kidney anomalies have severe growth impairment in all parameters, even falling behind those requiring dialysis in the neonatal period.”
In a single-center pilot study, researchers retrospectively analyzed data of 114 pregnancies that were referred for concerns of fetal kidney dysfunction between Jan. 1, 2014, to Dec. 31, 2018. All infants had severe congenital anomalies of the kidney and urinary tract (CAKUT) and survived for at least 30 days.
Researchers evaluated growth patterns among the infants who required dialysis in their first 30 days of life. They also collected somatic growth measurements of weight, length and head circumference during routine clinical care at birth, 2 weeks, 1 month, 2 months, 3 months, 4 months, 6 months, 9 months and 12 months of age. Additionally, the feeding patterns of infants were recorded at these time points.
A total of 24 infants were included in the final analysis, 17 of which required dialysis. Those requiring dialysis showed a “profound lag in all parameters” at 1 month and 2 months of age. This lag was most prominent in length and head circumference. Compared with infants with CAKUT who did not require dialysis, the growth trends were improved. However, linear growth did not normalize by 1 year.
Researchers identified a median duration of parenteral nutrition dependency of 46 days, with first enteral feed on day 7 of life. At 2 months following birth, all infants who did not require dialysis were on enteral feeds greater than 150 mL/kg per day of breast milk.
“Infants with end-stage kidney disease are at high risk for growth failure, most profound in the first 2 months of life,” Slagle and colleagues wrote. “This may be due to the high degree of systemic illness in this population during the neonatal period, but delays in initiation of enteral nutrition are likely contributory. Implications and associations related to this deficit on long-term outcomes are greatly needed as overall survival continues to improve. Interventions to improve growth and early nutrition with greater human milk provision, aggressive parenteral nutrition and optimized fluid status with early dialysis are all attractive targets for further study and may improve outcomes of neurodevelopment and mortality.”
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