Infants with congenital anomalies of kidneys and urinary tract at Increased risk of Growth failure

An original research article published in the Journal of Renal Nutrition has revealed increased risk of early growth failure among infants born with congenital anomalies of the kidney and urinary tract. (CAKUT)

As mentioned by NIH, kidneys play an essential role in children's growth. One of the most common complications of children born with chronic kidney disease is related to growth failure. Such children have a slow growth rate and are relatively short compared to children of the same age and sex.

The factors contributing to impaired growth in children with chronic kidney disease include malnutrition, metabolic acidosis, mineral and bone disorders, anemia, and fluid and electrolyte abnormalities. Moreover, after infancy and early childhood, growth failure is mainly due to disturbances in growth hormone (GH) metabolism and its central mediator, insulin-like growth factor-I (IGF-I). The data on infants with severe CAKUT remains limited.

Against the above background, Slagle et al. from the Division of Neonatology and Pulmonary Biology at Cincinnati Children's Hospital Medical Centre and the Department of Pediatrics from the University Of Cincinnati College Of Medicine with a research team examined growth patterns in infants with CAKUT requiring dialysis in the first 30 days.

The critical points of the study are:

• Data from 114 pregnancies were analyzed.

• Infants with severe CAKUT from 2014-2018 were evaluated. These infants survived for at least 30 days.

• Twenty-four infants met the inclusion criteria and were included in the study, and 17 required dialyses.

• According to standard infant curves, somatic growth parameters (weight, length, and head circumference) were recorded.

• Nutritional information and feeding pattern were also added to the record.

• Somatic growth was disrupted most profoundly at 1-2 months postnatal age.

• Growth trends were improved compared to infants with CAKUT that did not require dialysis.

• By one year of age, the Linear growth failed to normalize.

The co-researcher Stefanie Riddle wrote, "We found that infants with CAKUT have severe growth impairment in all parameters."

The median duration of parenteral nutrition dependency of 46 days, with the first enteral feed on day 7 of life. Infants (non-dialysis) were on enteral feeds greater than 150 ml/kg per day of breast milk at two months after birth.

Growth failure is intensely extreme in the first two months of life. Further studies are warranted to improve the outcomes, neurodevelopmental related and mortality in such cases. Nutritional requirements should be identified and targeted, especially during this period.

References:

• Single Center Experience on Growth in Infants Born with End Stage Kidney Disease. Cara L. Slagle

• Becherucci F, Roperto RM, Materassi M, Romagnani P. Chronic kidney disease in children. Clin Kidney J. 2016 Aug;9(4):583-91. doi: 10.1093/ckj/sfw047. Epub 2016 Jun 5.