Objective: To determine the clinical utility of serum neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of acute kidney injury in asphyxiated neonates with hypoxic ischemic encephalopathy (HIE).
Design: Cohort study.
Settings: National Intensive Care Unit of Maternity Hospital, Ain Shams University, Cairo, Egypt.
Patients: The study included 30 term asphyxiated neonates (8 with mild, 13 with moderate and 9 with severe HIE) and 20 control neonates.
Intervention: Serum NGAL level was measured within 6 hours after birth using an enzyme linked immunosorbent assay.
Main Outcome Measures: Patients were subsequently discriminated into AKI (n=12) and no-AKI (n=18) groups.
Results: The median (Interquartile range) serum NGAL concentration was 95.0 (70.75-180.00) ng/mL in asphyxiated neonates, and 39.75 (6.0-48.0) ng/mL in control neonates; (P<0.001). Serum NGAL correlated with HIE severity: mean (SD) was 65.50 (3.77) ng/mL in infants with mild HIE, 115.07 (45.83) ng/mL in infants with moderate HIE and 229.66 (79.50) ng/mL in infants with severe HIE; (P<0.01). The median (Interquartiles) serum NGAL level was 182.50 (166.25-301.75) ng/mL in patients with AKI, 74.00 (66.00-78.75) ng/mL in those without AKI; (P<0.001). A cutoff value 157 ng/mL for serum NGAL could detect AKI in asphyxiated neonates with a sensitivity of 83.3% and a specificity of 94.4%.
Conclusion: Elevated serum NGAL measured within 6 hours after birth reliably indicates acute kidney injury in asphyxiated neonates.
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