Aminophylline for Renal Protection in Neonatal Hypoxic Ischemic Encephalopathy in the Era of Therapeutic Hypothermia

BACKGROUND: Neonates with hypoxic ischemic encephalopathy (HIE) frequently develop acute kidney injury (AKI). Aminophylline has been shown to reduce severe renal dysfunction in neonates after perinatal asphyxia. However, the effect of aminophylline on renal function in neonates undergoing hypothermia has not been studied. METHODS: A single-center, retrospective chart review of neonates cooled for moderate/severe HIE who received aminophylline for AKI was conducted to assess changes in urine output (UOP) and serum creatinine (SCr). Comparisons were also made to control neonates matched for hours of life who were cooled but unexposed to aminophylline. RESULTS: Sixteen neonates cooled for HIE received aminophylline starting at 25 ± 14 hours of life. Within 12 hours of starting aminophylline, UOP increased by 2.6 ± 1.9 ml/kg/h. SCr declined by 0.4 ± 0.2 mg/dl in survivors over the first 4 days. When compared to control neonates, UOP increase was greater in the aminophylline group (p<0.001). SCr declined in survivors in both groups, although baseline SCr was higher in the aminophylline group. CONCLUSION: Aminophylline use in neonates with HIE undergoing hypothermia was associated with an increase in UOP and a decline in SCr. A randomized trial will be needed to establish a potential renal protective role of aminophylline.