Renal follow up of premature infants with and without perinatal indomethacin exposure

Aims-To evaluate early childhood renal growth, structure, and function in c hildren born at less than 33 weeks gestation and to investigate possible in dependent effects of perinatal indomethacin exposure. Methods-A total of 66 children born at less than 33 weeks gestation, 31 of them with perinatal indomethacin exposure (study group) and 35 without (con trol group), were examined at 2-4 years of age. Serum cystatin C and protei n; plasma creatinine, sodium, and potassium; urine protein, calcium:creatin ine ratios, and a, microglobulin; and glomerular filtration rate (GFR) were determined. Renal sonography examinations were performed. Results-The mean serum cystatin C concentrations were slightly higher in th e control group than in the study group. Mean values of serum protein, and plasma creatinine and sodium did not differ between the groups, neither did median plasma potassium concentrations and urine protein:creatinine and ca lcium:creatinine ratios. None had tubular proteinuria. Abnormal GFR (<89 ml /min/1.73 m(2)) was found in one case in each group and renal structural ab normalities in five in each group. In logistic regression analysis the dura tion of umbilical artery catheter (UAC) use and furosemide treatment emerge d as the significant independent risk factors for renal structural abnormal ities. Furosemide treatment and assisted ventilation remained the risk fact ors associated with renal abnormalities in general-that is, functional and/ or structural abnormal findings. Conclusion-Perinatal indomethacin does not seem to affect long term renal g rowth, structure, or function in children born at less than 33 weeks gestat ion. Duration of UAC use, furosemide treatment, and assisted ventilation ma y be correlated with later renal structural and functional abnormalities.