Management of impaired renal function in the newborn

Abstract

The neonatal kidney can adapt to the usual physiological processes occurring after birth and allow homeostatic regulation to transfer from the placenta to the kidney. However during this period of transition the neonatal kidney is vulnerable. It is less able to withstand stress such as hypotension, hypoxia or hypovolaemia which will result in a decrease in kidney function. It is therefore not unexpected that the incidence of acute renal failure in children is highest in the neonatal period, with an incidence similar to adult patients. This is more pronounced in the more immature infants. Improvements in perinatal and neonatal medicine have increased the survival chances of critically ill neonates. However mortality and morbidity rates remain significant for those newborns who have suffered from a kidney injury with a reported incidence of death in 25-50%.