Serum neutrophil gelatinase-associated lipocalin as a marker of acute kidney injury in asphyxiated neonates.

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.