Anuria in neonatal intensive care: Questions
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CLINICAL QUIZ
Anuria in neonatal intensive care: Questions Özgür Özdemir-Şimşek 1 & Seçil Arslansoyu-Çamlar 1 & Hüseyin Üstün 1 & İrem Nur İngenç 2 & Gökçen Erfidan 1 & Eren Soyaltın 1 & Melek Akar 1 & Demet Alaygut 1 & Fatma Mutlubaş 1 & Defne Engür 1 & Mehmet Yekta Öncel 1,3 & Belde Kasap-Demir 1,3 Received: 8 April 2020 / Revised: 9 April 2020 / Accepted: 16 April 2020 # IPNA 2020
Case presentation An 870-g male newborn was born at 30 weeks of gestation to a 30-year-old mother by cesarean section. His 1- and 5min APGAR scores were 5 and 7, respectively. The patient was admitted to a neonatal intensive care unit (NICU) with the diagnoses of prematurity, small for gestational age, and infant of mother with preeclampsia and respiratory distress. It was learned that the mother used alphamethyldopa with the diagnosis of preeclampsia. The physical examination revealed birth weight of 870 g (3–10 percentile), height of 34 cm (< 3 percentile), and head circumference of 24 cm (< 3 percentile). He had tachypnea and groaning. Ampicillin and gentamicin were initiated since neonatal sepsis could not be ruled out, and the case was followed with nasal continuous positive airway pressure. An umbilical artery catheter was inserted. Cranial ultrasonography performed on day 2 was normal, and patent ductus arteriosus was not detected on echocardiography. For the patient, whose blood pressure (BP) was 100/69 (> 95/95 percentile) on the postnatal day 4, 1.5-mg/kg/dose
The answers to these questions can be found at https://doi.org/10.1007/ s00467-020-04581-9. * Belde Kasap-Demir [email protected] 1
University of Health Sciences Izmir Tepecik Training and Research Hospital Department of Pediatrics, Division of Nephrology, Izmir, Turkey
2
University of Health Sciences Izmir Tepecik Training and Research Hospital Department of Pediatrics, Izmir, Turkey
3
İzmir Katip Çelebi University Department of Pediatrics, Division of Neonatology, Izmir, Turkey
thiazide and 1-mg/kg/dose propranolol were administered when necessary at different intervals. Kidney and Doppler ultrasonography, performed to investigate the underlying cause of hypertension, were normal. Since the patient was hypertensive despite those agents, another antihypertensive treatment was instituted on postnatal day 11. He was hypotensive and became anuric in the following 24 h, requiring intravenous bolus fluid, adrenaline, dopamine, and dobutamine. Peripheral blood count revealed a WBC count of 11.9 × 103/μL, hemoglobin of 11.9 g/dL, and a platelet count of 237 × 103/μL. Serum urea 114 mg/ dL, creatinine 2.7 mg/dL, uric acid 8 mg/dL, sodium 117 mmol/L, potassium 4.81 mmol/L, calcium 11.2 mg/ dL, phosphorus 2.8 mg/dL, CRP 12.3 mg/dL (N:0–5). pH 7.30, pCO2 31.8 mmHg, HCO3 15.6 mmol/L, and BE − 9.7 mmol/L. After the BP of the patient increased to normal limits for his gender and age, furosemide infusion was started with the dose of 0.1 mg/kg/h and increased gradually to 0.6 mg/kg/h; however the patient stayed anuric. Peritoneal dialysis was initiated on postnatal day 12
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