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Children
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Renal and Cardiovascular Consequences of Prematurity
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Renal and Cardiovascular Consequences of Prematurity

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Global Pediatric Health".

Deadline for manuscript submissions: closed (20 April 2025) | Viewed by 5417

Special Issue Editors

Dr. Anke Raaijmakers

E-Mail Website
Guest Editor
1. Department of Paediatric Nephrology, Sydney Children’s Hospital Randwick, Sydney Children’s Hospital Network, Randwick, NSW 2031, Australia
2. School of Women's and Children's Health, University of New South Wales, Randwick Clinical Campus, Randwick, NSW 2031, Australia
Interests: prematurity; cardiovascular disease in childhood; hypertension; developmental nephrology
Dr. Eveline Staub

E-Mail Website
Guest Editor
1. Department of Neonatology, Royal North Shore Hospital, St Leonards, NSW, Australia
2. University of Sydney Northern Clinical School, Royal North Shore Hospital, St Leonards, NSW, Australia
Interests: prematurity; cardiovascular disease in childhood; hypertension; developmental nephrology

Special Issue Information

Dear Colleagues,

Through this Special Issue, we would like to increase awareness regarding the long-term cardiovascular consequences of preterm birth.

Acceptable articles for this Special Issue include original research articles or reviews related to this topic. Neonatologists sharing their knowledge on the early prevention of kidney injury is also welcome. Avoiding hit after hit for the cardiovascular system and the kidneys would be an excellent prevention strategy that we look forward to highlighting.

Dr. Anke Raaijmakers
Dr. Eveline Staub
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Children is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2400 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • prematurity
  • hypertension
  • low birth weight
  • developmental nephrology

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (4 papers)

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Review

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12 pages, 465 KiB  
Review
Dexmedetomidine: Shifting Paradigms in Neonatal Sedation and Pain Control
by Kok Joo Chan and Srinivas Bolisetty
Children 2025, 12(4), 444; https://doi.org/10.3390/children12040444 - 30 Mar 2025
Viewed by 653
Abstract
Background: Newborns, including preterm infants, are capable of responding to pain. Recurrent pain exposure is associated with suboptimal motor development, cognitive impairments, abnormal brain growth, and maladapted nociceptive reactions. Problem: Current agents, primarily opioids and benzodiazepines, raise major concerns due to their adverse [...] Read more.
Background: Newborns, including preterm infants, are capable of responding to pain. Recurrent pain exposure is associated with suboptimal motor development, cognitive impairments, abnormal brain growth, and maladapted nociceptive reactions. Problem: Current agents, primarily opioids and benzodiazepines, raise major concerns due to their adverse effects, including insufficient sedation or analgesia, withdrawal, depressed respiratory effort, tolerance, and occasional paradoxical agitation. Commonly used drugs such as midazolam and morphine have been shown to induce neuroapoptosis and neurodevelopmental abnormalities in animal studies. Evaluation—Dexmedetomidine: As a specific alpha-2 adrenergic agonist, dexmedetomidine causes a significantly lower reduction in breathing effort. It has over 800 times greater affinity for alpha-2 receptors compared to alpha-1 receptors. Common side effects include bradycardia and hypotension. Prolonged use may necessitate a transition to clonidine during the weaning process. Dexmedetomidine can be administered intravenously as a bolus or infusion or intranasally. Indications include sedation and analgesia for mechanical ventilation, therapeutic hypothermia, procedural premedication, and as an adjunct to inhalational anesthesia and nerve-blocking agents. Research across varying age groups has demonstrated that dexmedetomidine shortens periods of invasive ventilation and decreases the need for other sedatives. Neonatal studies suggest that dexmedetomidine may help accelerate the achievement of full enteral feeds and can be safely administered within specific dosage ranges without causing significant adverse events that would necessitate abrupt discontinuation. Conclusions: Dexmedetomidine can be used alone or in combination with other agents. By increasing the use of dexmedetomidine, it is possible to reduce the dosage of concurrent medications, thereby minimizing the risk of complications while still achieving the desired sedation and analgesia. Full article
(This article belongs to the Special Issue Renal and Cardiovascular Consequences of Prematurity)
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14 pages, 696 KiB  
Review
Neonatal Kidney Function, Injury and Drug Dosing: A Contemporary Review
by Eveline Staub, Srinivas Bolisetty, Karel Allegaert and Anke Raaijmakers
Children 2025, 12(3), 339; https://doi.org/10.3390/children12030339 - 7 Mar 2025
Viewed by 1233
Abstract
In neonates, estimation of the glomerular filtration rate is problematic, and assessment of renal impairment is challenging. Serum creatinine is a widely used marker, and urine output is an important vital parameter monitored in intensive care settings, particularly in unwell neonates. However, the [...] Read more.
In neonates, estimation of the glomerular filtration rate is problematic, and assessment of renal impairment is challenging. Serum creatinine is a widely used marker, and urine output is an important vital parameter monitored in intensive care settings, particularly in unwell neonates. However, the rapid changes after birth with adaptation to the extrauterine environment is a unique situation in which absolute serum creatinine is not a reliable indicator of renal function. A rise in serum creatinine from the previous value during the neonatal period can be a result of worsening renal function in neonates but is dependent on many other factors. In addition, urine output can be difficult to measure in sick neonates during their intensive care stay. Despite a high prevalence of acute kidney injury (AKI) in preterm and/or unwell infants, the current definitions are not straightforward and do not take postnatal adaptation processes into account. The management of AKI is challenging in very young and small patients because the assessment of fluid status as well as balancing nutritional needs with fluid restriction can be problematic. The Australian Neonatal Medicines Formulary provides advice on drug dosing in the face of reduced renal function in neonates. Predictors (or long-term outcome, or recovery) after AKI diagnosis are still poorly described. Therefore, the diagnosis of neonatal AKI needs to be documented and transferred to the paediatrician responsible for the follow-up of the child. This educational review aims to give a perspective on neonatal kidney function and AKI, the relation of fluid balance and creatinine, the management of neonatal AKI and the consequences for drug dosing and long-term outcomes. Full article
(This article belongs to the Special Issue Renal and Cardiovascular Consequences of Prematurity)
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22 pages, 1596 KiB  
Review
Preterm Birth and Kidney Health: From the Womb to the Rest of Life
by You-Lin Tain and Chien-Ning Hsu
Children 2024, 11(10), 1213; https://doi.org/10.3390/children11101213 - 2 Oct 2024
Cited by 1 | Viewed by 1873
Abstract
Chronic kidney disease (CKD) is a widespread condition often resulting from multiple factors, including maternal influences. These risk factors not only heighten the likelihood of developing CKD but increase the risk of a preterm birth. Adverse events during nephrogenesis can disrupt kidney development, [...] Read more.
Chronic kidney disease (CKD) is a widespread condition often resulting from multiple factors, including maternal influences. These risk factors not only heighten the likelihood of developing CKD but increase the risk of a preterm birth. Adverse events during nephrogenesis can disrupt kidney development, leading to a reduced number of nephrons. As survival rates for preterm infants improve, more individuals are living into adulthood, thereby elevating their risk of CKD later in life. This review aims to explore the connections between preterm birth, kidney development, and the increased risk of CKD, while proposing practical solutions for the future through a multidisciplinary approach. We examine human studies linking preterm birth to negative kidney outcomes, summarize animal models demonstrating kidney programming and reduced nephron numbers, and consolidate knowledge on common mechanisms driving kidney programming. Additionally, we discuss factors in the postnatal care environment that may act as secondary insults contributing to CKD risk, such as acute kidney injury (AKI), the use of nephrotoxic drugs, preterm nutrition, and catch-up growth. Finally, we outline recommendations for action, emphasizing the importance of avoiding modifiable risk factors and implementing early CKD screening for children born preterm. Together, we can ensure that advancements in kidney health keep pace with improvements in preterm care. Full article
(This article belongs to the Special Issue Renal and Cardiovascular Consequences of Prematurity)
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9 pages, 875 KiB  
Systematic Review
Hypo- and Hypernatremia in Extremely Low Birth Weight Infants in the First 10 Days of Life: A Review
by Myrna Pace, Stijn van Sas, Thomas Salaets, Annouschka Laenen, Anke Raaijmakers and Karel Allegaert
Children 2025, 12(2), 231; https://doi.org/10.3390/children12020231 - 13 Feb 2025
Cited by 1 | Viewed by 977
Abstract
Background/Objectives: Sodium regulation is critical in extremely low birth weight (ELBW, <1000 g) infants. This study aimed to provide a comprehensive overview of sodium dynamics and related variables in ELBW infants in their first 10 days of life through a structured literature review. [...] Read more.
Background/Objectives: Sodium regulation is critical in extremely low birth weight (ELBW, <1000 g) infants. This study aimed to provide a comprehensive overview of sodium dynamics and related variables in ELBW infants in their first 10 days of life through a structured literature review. Methods: Applying PRISMA guidelines, six databases were searched (1 August 2023) on sodium measurements in ELBW cohorts, with quality assessment (RoB2, ROBINS-1, Newcastle Ottawa scale) of retained papers, and subsequent data extraction in line with these PRISMA guidelines to describe findings. Results: Only eight heterogeneous studies could be retained, including observational cohort studies (n = 5), case–control studies (n = 2, Tegaderm application yes/no, gestational age < 24 or 24–28 weeks), and only one randomized trial (sodium restriction versus no sodium restriction). Definitions of hyper- or hyponatremia were also heterogeneous, with incidence ranges for hyper- (8–92.2%) and hyponatremia (0–52.9%). Peak sodium values were observed on days 2–4 in the individual studies. When pooled and compared to the cohort mean sodium values, the highest increases in mean serum sodium values were observed on day 3 (+4, range, −0.6 to +8.6 mEq). Variables of sodium values were related to care factors [incubator settings (open/closed, double-/not double-walled, humidity), fluid regimens (water volume, sodium supplementation), occlusive skin care], as well as related maturational factors (postnatal age, gestational age, small versus appropriate for gestational age, SGA/AGA). Conclusions: Based on a structured literature review, patterns of sodium changes over postnatal age in ELBW cases were documented. Besides incubator settings, fluid regimens, or occlusive skin care, these patterns also depend on maturational factors of the ELBW infant (gestational age, postnatal age, SGA/AGA). These complexities emphasize the need for nuanced interpretation, the relevance of standardizing clinical practices and research definitions, and the need to report on additional datasets. Full article
(This article belongs to the Special Issue Renal and Cardiovascular Consequences of Prematurity)
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