NIRS for the Diagnosis and Prevention of Acute Renal Failure
NIRS for the Diagnosis and Prevention of Acute Renal Failure
This prospective study will take place at Hotel Dieu de France hospital in Lebanon. One
 hundred children undergoing cardiac surgery for congenital heart disease between May 2020 and
 May 2021 will be included. After obtaining the informed consent of the parents, demographic
 and surgical information will be collected. Serum creatinine, lactic acid, urinary neutrophil
 gelatinase-associated lipocalin marker (NGAL), and oxygen (O2) saturation will be measured
 before the operation.

 A pediatric NIRS sensor will be placed on the right side below the costo-vertebral angle
 overlying the right kidney and continuous regional oxygen saturation (rSO2) will be recorded
 every 5 to 10 minutes throughout the operation until 24 hours after surgery. The children
 will be divided into 2 groups; 50 each. Grp 1: No clinical intervention was performed based
 on NIRS values. Grp 2: several maneuvers are performed such as an increase in cardiac output,
 temperature, hemoglobin to optimize the value of NIRS > 80%. All patients will receive
 standard standard care during the study period and continuous infusion of furosemide (0.5-1
 mg / kg / 6 hours) within the first 24-48 hours postoperatively will be administered to all
 patients. Creatinine and lactic acid will be measured immediately postoperatively and then
 once a day until D2 and D7.

 The urinary NGAL marker will be dosed immediately postoperatively and then at 2h, 6h, 12h and
 24h with hourly monitoring of diuresis and NIRS until 24h postoperatively.
This prospective study will take place at Hotel Dieu de France hospital in Lebanon. One
 hundred children aged 16 and under, undergoing cardiac surgery with cardiopulmonary bypass
 (CPB) for congenital heart diseases will be included between May 2020 and May 2021. The
 surgeries to be included will be the tetralogy of Fallot, transposition of the great
 arteries, ventricular septal defect, atrial septal defect and the atrioventricular canal
 defect. Any premature under 35 weeks of gestation, the presence of a genetic disease, an
 abnormal renal ultrasound, a preoperative renal failure with creatinine abnormal for age, or
 repeated urinary tract infections will be excluded from the study. After obtaining the
 informed consent of the parents, demographic information (age, weight, height, sex) will be
 collected..

 Serum creatinine, lactic acid, urinary NGAL marker, and O2 saturation will be measured before
 the operation.

 A pediatric NIRS sensor will be placed on the right side below the costo-vertebral angle
 covering the right kidney and continuous rSO2 will be recorded every 5 to 10 minutes
 throughout the operation as well as with each change of situation, then every hour in
 pediatric resuscitation until 24 hours postoperatively. The children will be divided into 2
 groups of 50 patients each; Grp 1: No clinical intervention will be performed based on the
 NIRS and Grp 2: several maneuvers will be performed in case the NIRS values are below 50%,
 such as an increase in cardiac output, temperature, hemoglobin to optimize the NIRS value by
 up to 80%.

 Surgical information (cardiac pathology, surgical procedure, operating time, duration of CPB,
 duration of aortic cross-clamping, duration of circulatory arrest, intraoperative
 complications) will be collected.

 All patients will receive standard standard care during the study period. Patients will
 receive continuous infusion of furosemide (0.5-1 mg / kg / 6 hours) within the first 24-48
 hours postoperatively.

 Postoperatively, the need for catecholamines, the hemodynamic stability according to the
 Vasoactive-Inotropic Score (VIS), the delay to extubation, the stay in intensive care, the
 complications that occurred and the need for recourse to the dialysis will be noted.

 Creatinine and lactic acid will be measured immediately postoperatively and then once a day
 until D2 and D7.

 The urinary NGAL marker will be dosed immediately postoperatively and then at 2h, 6h, 12h and
 24h with hourly monitoring of diuresis and NIRS until 24h postoperatively.
Inclusion Criteria:

 -  Pediatric patients aged 16 years and under, undergoing cardiac surgery with
 cardiopulmonary bypass at the hotel Dieu de France Hospital, from September 2020 until
 September 2021.

 -  Surgeries to include: Tetralogy of Fallot, Transposition of great Vessels, ventricular
 septal defect, atrial septal defect and atrioventricular septal defect.

 -  Normal renal function

 -  Informed consent written and signed by the child's parents

 Exclusion Criteria:

 -  The refusal of the patient's parents

 -  Patients with preoperative AKI

 -  Identification of renal or urinary anatomical abnormalities

 -  Premature infants <35 weeks of gestation

 -  Children with a known genetic or chromosomal abnormality

 -  Destination to a uni ventricular repair

 -  Repeated urinary tract infections before the surgery