Korean Journal of Pediatrics 2004;47(3):275-281.
Published online March 15, 2004.
Risk Factors of Nephrocalcinosis in Very Low Birth Weight(VLBW) Infants
Gyu Hong Shim, Jin A Lee, Yun Jung Shin, Ee Kyung Kim, June Dong Park, Beyong Il Kim, Jung Hwan Choi
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
극소 저출생 체중아에서 신석회화증의 위험인자
심규홍, 이진아, 신윤정, 김이경, 박준동, 김병일, 최중환
서울대학교 의과대학 소아과학교실
Correspondence: 
Jung Hwan Choi, Email: neona@plaza.snu.ac.kr
Abstract
Purpose
: Nephrocalcinosis in very low birth weight(VLBW) infants were known to be caused by a longer duration of furosemide use. However, etiologies, pathogenesis and risk factors remain unclear. Therefore, we examined the incidence and risk factors of nephrocalcinosis in VLBW infants retrospectively.
Methods
: Inborn babies of birth weights less than 1,500 gm were examined retrospectively. Data were reviewed on gestational age, birth weight, sex, 5-min Apgar score, oliguria on the first day, respiratory support, surfactant use, duration of nephrotoxic drug use(furosemide, gentamicin, amikin, vancomycin and amphotericin-B) and duration of total parenteral nutrition(TPN) use. Presence of bronchopulmonary dysplasia(BPD), bacterial sepsis, fungal sepsis, osteopenia and necrotizing enterocolitis(NEC) were also reviewed. Serum calcium, phosphorus, total protein, albumin, blood urea nitrogen (BUN) and creatinine at three to five weeks of age and at discharge were reviewed.
Results
: A t-otal 141 infants were reviewed. 9.2%(13/141) of VLBW infants developed nephrocalcinosis. By univariate analysis, gestational age, birth weight, 5-min Apgar scores, duration of ventilation, duration of oxygen use, postnatal dexamethasone, phototherapy, nephrotoxic drugs(furosemide, amikin, vancomycin, and amphotericin) and TPN were significantly associated with nephrocalcinosis. Low phosphorus level at three to five weeks of age and high BUN levels at discharge were significantly associated with nephrocalcinosis. Presence of RDS, BPD, bacterial sepsis, fungal sepsis and NEC were also significantly associated with nephrocalcinosis. Multivariate analysis showed that the strongest predictors of nephrocalcinosis were duration of furosemide use and birth weight.
Conclusion
: Longer duration of furosemide use and lower birth weight are considered to be independent risk factors. Further more prospective and longterm follow up studies are needed.
Key Words: Nephrocalcinosis, Very low birth weight infants, Risk factors, Incidence, Logistic regression


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