627 - Outcomes of Neonates Born to Women with Chronic Kidney Disease

Publication Number: 627.5880

Jaya Isaac, The Children's Hospital at Montefiore, Bronx, NY, United States; Ladan Golestaneh, Yale School of Medicine, New Haven, CT, United States; Sonali gupta, Albert Einstein College of Medicine, Bronx, NY, United States; Kimberly J. Reidy, The Children's Hospital at Montefiore, Bronx, NY, United States

Background: Chronic kidney disease (CKD) in pregnancy has been associated with greater risk for pre-eclampsia, preterm birth, and small for gestational age/low birth weight neonates. Little is known about the outcomes of these infants.

Objective: Our hypothesis was that neonates born to women with CKD would be at risk for adverse kidney outcomes including neonatal acute kidney injury (AKI), elevated blood pressure (BP), and estimated glomerular filtration rate (eGFR) impairment.

Design/Methods: We performed a retrospective chart review examining characteristics of infants born to mothers with CKD who were admitted to our neonatal intensive care unit from 2016 to 2020. Maternal CKD was defined as eGFR < 75 ml/min/1.73m2 or urine protein to creatinine ratio > 0.2 g/g. For offspring, we assessed for neonatal hypertension and AKI using modified neonatal KDIGO creatinine criteria, as well as serum creatinine and blood pressure at most recent follow up.

Results: We identified 46 neonates (45% male) born to mothers with CKD who were admitted to the NICU. 35 were born preterm, with a median gestational age of 34 weeks (IQR 32.6, 37.7 weeks). Maternal CKD was only reported in 18 (39%) of the infant’s charts. The neonates overall had a benign NICU course with one neonate developing AKI and none diagnosed with neonatal hypertension. Our average follow-up time was 4.5 years. 13 of the offspring had their creatinine checked after 1 year of age, with median eGFR by Chronic Kidney in Children (CKiD) Under 25 equation of 74.9 ml/min/1.73m2 (IQR 69.0, 81.8). 33 neonates had blood pressures checked after 1 year of age with 24.2% and 33% having a systolic and diastolic blood pressure ≥ 90th percentile, respectively.

Conclusion(s): CKD in pregnancy poses risks to both the mother and infant, with increased risk for preterm birth resulting in low nephron development. Our report highlights the lack of recognition of maternal CKD and the potential for elevated BP and eGFR impairment in neonates born to women of CKD. Following these infants through the life course may help better understand their future risk for adverse outcomes.