OBJECTIVE: In very preterm infants, there is a high risk for impaired kidney function; therefore, access to normal ranges of glomerular filtration rate (GFR) for age and definition of a reliable normal range of glomerular clearance is essential. Despite this, updated GFR reference values for use in clinical practice are not available. The objective of this study was to determine GFR reference values in very preterm infants aged 27 to 31 weeks' gestation. METHODS: This was a multicenter, prospective cohort study. Infants were recruited to the study before 48 hours of life. Glomerular clearance was measured at inclusion, then weekly for the first month. Reference values were determined by measurement of 12-hour urine specimens and generation of a linear regression model with repeated measures after removal of risk factor components. Validation was checked with a bootstrap technique for infants who were not exposed to significant risk factors. RESULTS: This study included 275 infants. Median GFR reference values (mL/min per 1.73 m(2)) in infants aged 27 to 31 weeks' gestation ranged from 7.9 to 30.3 on day 7, 10.7 to 33.1 on day 14, 12.5 to 34.9 on day 21, and 15.5 to 37.9 on day 28. CONCLUSIONS: The GFR reference values, presented in this article as 3rd, 10th, 50th, 90th, and 97th percentiles, should be useful in NICUs for adaptation of drug doses to glomerular clearance and in defining infants who present with altered GFR and who need additional investigation and close follow-up to adjust fluid intake and drug dosage.
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机译：目的：在早产儿中，肾功能受损的风险很高。因此，进入年龄范围的肾小球滤过率（GFR）正常范围和确定可靠的正常肾小球清除率范围至关重要。尽管如此，仍无法获得用于临床实践的更新的GFR参考值。这项研究的目的是确定妊娠27至31周的早产儿的GFR参考值。方法：这是一项多中心，前瞻性队列研究。婴儿在生命48小时之前被招募到研究中。在纳入时测量肾小球清除率，然后在第一个月每周一次。参考值是通过测量12小时尿液样本并在去除危险因素成分后重复测量生成线性回归模型来确定的。对于没有暴露于重大危险因素的婴儿，使用bootstrap技术检查其有效性。结果：该研究包括275名婴儿。妊娠27至31周的婴儿的GFR参考值中位数（mL / min / 1.73 m（2））在第7天的第7.9至30.3天，在第14天的10.7至33.1，第21天的12.5至34.9以及第15.5至15在第28天时为37.9。结论：本文的GFR参考值分别为第3、10、50、90和97个百分位数，可用于重症监护病房，以使药物剂量适应肾小球清除率，并确定表现出改变的婴儿GFR，需要进一步调查并密切随访以调整体液摄入量和药物剂量的人。
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