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Déterminants de la fonction rénale d'enfants nés grands prématurés dans leur environnement néonatal et dans l'enfance

Abstract : Background: Physiological development of renal may be altered in preterm infants by environmental factors. Their imprinting could persist beyond the neonatal period. Objectives: 1) to determine reference values of glomerular filtration rate (GFR) during the first month of life in preterm newborns, 2) to determine the impact of perinatal factors and of the drugs often prescribed on their renal function, 3) to determine the effect of the perinatal imprinting, and of the growth and height catch-up, on their renal function in early childhood. Sample: Multicentre cohort of children born very preterm at 27-31 weeks of gestation, with a measure of their renal function during the neonatal period, and at 4 years of age. Results: 1) 275 infants included. Median reference GFR value (mL/min/1.73m²) was: 7.9 on day7 to 37.9 on day 28. 2) GFR was significantly reduced on day 7 in ibuprofen-infused infants in comparison to Controls: 12.8±6.2 vs. 18.1±12.1 ml/min/1.73 m², p < 0.001. This decrease persisted throughout the first month of life, and tubular function was also altered. Among all antenatal drugs and drugs administered during the first week of life, alone ibuprofen was significantly associated with a GFR < median reference value on day 7. 3) Height >= -1 SD in early childhood was associated with a high albuminuria in 119 four year-old preterm-born children. Conclusion: i) These GFR reference values are to be used in clinical research, ii) Neonatal therapeutic environment impairs renal function and delays its maturation, iii) The height at age four is an independent risk factor of high albuminuria in preterm-born children.
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Rachel Vieux. Déterminants de la fonction rénale d'enfants nés grands prématurés dans leur environnement néonatal et dans l'enfance. Médecine humaine et pathologie. Université Henri Poincaré - Nancy 1, 2011. Français. ⟨NNT : 2011NAN10095⟩. ⟨tel-01746241⟩

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