A Systematic Review and Meta-Analysis of Theophylline for Acute Kidney Injury in Asphyxiated Neonates

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  • February 27, 2019
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  • Rummings, Kelli
    • Affiliation: Gillings School of Global Public Health, Public Health Leadership Program
Abstract
  • Background: Perinatal asphyxia is caused by decreased oxygen delivery to neonates during the birthing process, and leads to significant neonatal morbidity and mortality. Acute kidney injury due to decreased oxygen delivery is a major adverse neonatal health outcome associated with perinatal asphyxia, and can lead to renal failure. Previous studies in low resource settings lacking induced hypothermia (the current standard of care in well-resourced countries) have used theophylline administered immediately following asphyxiation to prevent (or reduce) kidney injury. Purpose: To synthesize the current evidence on prophylactic theophylline in term infants with perinatal asphyxia for the prevention or treatment of acute kidney injury. Methods: PubMed and EMBASE were searched from database inception through April 2016 using predefined criteria to identify RCTs comparing prophylactic theophylline to placebo in term infants following perinatal asphyxia examining incidence of acute kidney injury (AKI), serum creatinine levels (SCr), or glomerular filtration rates (GFR). Results: Five RCTs met full inclusion criteria (N=356 infants) and were included in meta-analysis. The use of prophylactic theophylline was associated with a significant reduction in acute kidney injury compared with placebo (RR 0.36, 95% CI, 0.25 to 0.5; p <0.00001). SCr levels were significantly lower in the theophylline group on days 3 and 5. Similarly, GFR levels were significantly increased on days 3 and 5 in the theophylline group compared to the control group. Conclusions: Prophylactic theophylline administration significantly reduces the incidence of acute kidney injury in asphyxiated term neonates and should be considered for routine use in low-resource settings lacking access to therapeutic hypothermia. Future research should examine theophylline in conjunction with therapeutic hypothermia, optimal dosing, and safety.
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  • In Copyright
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  • Track: HC&P
  • Paper type: Systematic review
Advisor
  • Feltner, Cynthia
Reviewer
  • Laughon, Matthew
Degree
  • Master of Public Health
Academic concentration
  • Public Health
Degree granting institution
  • University of North Carolina at Chapel Hill
Graduation year
  • 2017
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  • 8b04557f-2b31-43d7-9956-15489d1341bd

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