Routine Diaper Change Alters Kidney Oxygenation in Premature Infants: A Non-A Priori Analysis

Background: Reduction in oxygen delivery to developing kidneys of premature infants may be an important source for acute kidney injury in premature infants. Purpose: To describe changes in continuous kidney oxygenation (RrSO₂) measures before, during, and after routine diaper changes. Methods: Non-a priori analysis of a prospective cohort that received continuous measurement of RrSO₂with near-infrared spectroscopy (NIRS) over the first 14 days of life demonstrating acute RrSO₂drops surrounding diaper changes. Results: In total, 26 of 38 (68%) infants (≤1800 g) from our cohort exhibited acute drops in RrSO₂that temporally correlated with diaper changes. Mean (SD) RrSO₂baseline prior to each diaper change event was 71.1 (13.2), dropped to 59.3 (11.6) during diaper change, and recovered to 73.3 (13.2). There was a significant difference between means when comparing baseline to diaper change (P <.001; 95% CI, 9.9 to 13.8) and diaper change to recovery (P <.001; 95% CI, -16.9 to -11.2). The mean decrease in RrSO₂during diaper change averaged 12 points (17%) below 15-minute RrSO₂mean prior to diaper change, with quick recovery to prediaper change levels. No decreases in SpO₂, blood pressure, or heart rate were documented during the intermittent kidney hypoxic events. Implications for Practice and Research: Routine diaper changes in preterm infants may increase the risk for acute reductions in RrSO₂as measured by NIRS; however, the impact on kidney health remains unknown. Larger prospective cohort studies assessing kidney function and outcomes related to this phenomenon are needed.