Frequency of Confirmed Congenital Renal Malformations in Neonates with Antenatal Diagnosis of Renal Anomalies Presenting in Neonatal Intensive Care Unit of a Tertiary Care Setting of a Low Income Country

Frequency of Confirmed Congenital Renal Malformations in Neonates with Antenatal Diagnosis of Renal Anomalies Presenting in Neonatal Intensive Care of of a Pediatrics, Perinatology Abstract Introduction: Approximately 20 to 30% of all anomalies identified in the prenatal period are congenital anomalies of the kidney and urinary tract (CAKUT). Widespread antenatal screening has resulted in increased detection of anomalies of the kid-neys and urinary tract. There are limited studies on the postnatal confirmation of these antenatally detected renal malformations. Moreover, there is no local data available in this regard. So, we conducted the study so that we can obtain local data as well as we can plan management and prevention protocols for such chronically, and sometimes critically, ill neonates. was found higher in neonates presenting with antenatal diagnosis of renal anomalies presenting in the neonatal intensive care unit.

cases. The sampling technique was non-probability consecutive sampling. All neonates aged 1-28 days of either gender admitted in NICU with antenatal diagnosis of congenital renal anomalies on anomaly scan were included in the study. Preterm neonates (gestational age below 34 weeks) and neonates having siblings with similar congenital problems were excluded.

Results:
The mean age of the neonates in our study was 10.17 ±9.30 days and the mean gestational age at birth was 36.65 ±1. 16 weeks. The majority of the neonates, that is 65%, were males while 35% were females. Sixty-six per cent (66%) neonates were ≤10 days of age while 34% were >10 days of age. Fifty five% of the neonates were ≤36 weeks of gestation at birth while 45% were >36 weeks of gestation at birth.
Neonates whose age at presentation was >10 days were slightly more likely to have confirmed congenital renal malformation as compared to neonates with ≤10 days of age, which is 85. 3 [1]. Widespread antenatal screening has resulted in increased detection of anomalies of the kidneys and urinary tract [2].
Currently majority of the congenital renal malformations, including CAKUT, are detected antenatally with the use of high sensitivity fetal ultrasonography [3]. Gestational age based parameters for expected length (appropriate growth) are also available. In the prenatal period, congenital abnormalities of the kidneys and urinary tract (CAKUT) are the most common sonographically identified malformations. Obstructive uropathies account for the majority of cases [4].
As compared to earlier scanning, mid-trimester ultra- Although CKD occurs less often in children than adults, still children account for about 2% of all patients with ESRD [6]. Mild forms of congenital kidney disease that appear relatively benign during the childhood may progress to ESRD later in adult life [7]. Literature has shown that the incidence of confirmed congenital renal malformations is high among neonates who had an antenatal diagnosis of a renal anomaly during the fetal stage (inside the womb) [8][9][10]. But later study reported the frequency is little lower than previous which showed ambiguity that antenatal diagnosis might have flaws in diagnosis. Moreover, there is no local data available in this regard. So, we conducted the study so that we can gain local data as well as we can plan management and prevention protocols for such critically ill neonates.  Table 3.

Discussion
Among all sonographically detected antenatal malformations, congenital abnormalities of the kidneys and the urinary tract are the most common.
Obstructive uropathies account for the majority of cases [4]. Renal tract malformations can be familial, was observed up to 81.2% in a European study conducted in 12 countries [11]. Postnatal confirmation of antenatally identified congenital renal malformations was observed in 78% of neonates.
Our data is almost comparable to the study from confirmed to have renal malformations postnatally [12].
In our study males were predominantly affected as compared to female neonates with a male to female ratio of 1

Conclusion
The frequency of confirmed congenital renal malformation was found higher in neonates presenting with antenatal diagnosis of renal anomalies presenting in the neonatal intensive care unit.

Ethics approval
This study was waived for ethical approval from ethical review committee of National Institute of Child Health Karachi.

Consent for publication
Informed consent obtained from parents/guardians.

Accordance
All methods were performed in accordance with the relevant guidelines and regulations

Availability of data and materials
Most of the data generated or analyzed during this study are included in this article. Limited data can be provided in person on request to the main author.

Competing interests
The authors declare that they have no competing interests.

Funding
This study was not funded by any institution or organization.

Authors' contributions
QS was the main author who collected data from neonates' parents/guardians and analyzed and interpreted that data. AJ was a major contributor in writing the manuscript along with study design. SF helped in collecting data and interpreting patient's reports and ultrasounds. JP helped in study design and he supervised whole study i.e. from data collection to writing manuscript. All authors read and approved the final manuscript.