J. Bryan Carmody, MD
Dr. Carmody is a pediatric nephrologist at the Children’s Hospital of the King’s Daughters in Norfolk, Virginia; an assistant professor of pediatrics at Eastern Virginia Medical School; and a partner at Children’s Specialty Group, PLLC. Follow him @jbcarmody.
Competitors for the Women’s Health Region
If neonatologists shared the same nerdy enthusiasm for basketball-themed education as their nephrology colleagues, and “NeoMadness” were a thing, it’s a safe bet that surfactant to treat respiratory distress syndrome would be the #1 seed and perennial favorite. Few interventions in any area of medicine have been as transformative. Before 1980, when surfactant use in premature neonates was first reported, extreme prematurity was often a death sentence. Yet by 2010, nearly 90% of neonates weighing 501-1500 g survived to NICU discharge.
Unfortunately, prematurity poses both short- and long-term risks to kidney health. AKI occurred in 48% of neonates born at <29 weeks gestation in the multicenter, international AWAKEN cohort, with AKI associated with a nearly four-fold increase in odds for mortality in this group. NICU survivors face an increased risk for CKD, and CKD risk factors are often present at young ages: analysis of NHANES data found that nearly one third of American adolescents with a history of very low birth weight (< 1500 g) had either elevated systolic blood pressure, eGFR < 90 ml/min/1.73 m2, or both, by ages 12-15.
Today, with the first generation of patients treated with surfactant just reaching young adulthood, the impact of prematurity on kidney function is only beginning to be appreciated. Recognizing the potentially enormous impact of measures to limit the impact of prematurity and low birth weight on long-term kidney outcomes, a working group of neonatologists, nephrologists, and obstetricians have published public health recommendations designed to reduce the future burden of CKD and hypertension. Such coordinated interventions hold great promise for improving global health – so look for “Prematurity’s Global Impact” to make a deep run in this year’s NephMadness tournament.
– Post written by J. Bryan Carmody
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