Prognostic factors in neonatal acute renal failure.

A retrospective study was conducted to evaluate the prognosis of acute rena l failure (ARF) in neonates and to identify factors predictive of death or of residual neurological or renal function impairment. Fifty-seven neonates admitted to a polyvalent pediatric intensive care unit between 1990 and 19 95 were included based on serum creatinine elevation above 150 mu mol/l wit hin 28 days of birth. Anuria was present in 32 cases and oliguria in 11. Se rum sodium was lower than 130 mmol/l in 44 cases and serum potassium higher than 5 mmol/l in 38 cases. Peritoneal dialysis was used in 14 patients and hemo filtration in six. There were 29 in-hospital deaths, and 83% of all d eaths were due to prerenal causes of ARF. Among the 28 survivors, six had a developmental delay and three had chronic renal failure defined as serum c reatinine levels greater than 50 mu mol/l beyond six months of age correcte d for gestational age at birth. In this retrospective study, four factors w ere associated with a greater risk of death or residual neurological impair ment, namely age younger than 24 h at admission, the underlying condition, low or absent urine output, and multiorgan failure syndrome. In most cases, even those treated by renal support techniques, renal function returned to normal.