Serum creatinine levels to estimate kidney function in small-for-gestational age and appropriate-for-gestational age newborns

Kidney Function in Small for Gestational Age Newborn

  • Indra Sandinirwan Universitas Padjadjaran, Dr. Hasan Sadikin General Hospital Bandung
  • Aris Primadi Department of Child Health, Universitas Padjadjaran Medical School/Dr. Hasan Sadikin Hospital, Bandung, West Java
  • Dany Hilmanto Department of Child Health, Universitas Padjadjaran Medical School/Dr. Hasan Sadikin Hospital, Bandung, West Java
Keywords: creatinine; kidney function; small for gestational age


Background The main parameter used to determine renal function in newborns is serum creatinine. Fetal growth restriction during pregnancy can cause the baby to be born small-for-gestational age. Serum creatinine levels in newborns are affected by muscle mass, gestational age, as well as the number of nephrons and kidney development.

Objective To determine the usefulness of serum creatinine levels as an estimate of glomerular filtration rate in small-for-gestational age and appropriate-for-gestational age newborns.

Methods This cross-sectional study was conducted in May-June 2018. The subjects were full term newborn infants consisting of small-for-gestational age and appropriate-for-gestational age groups (16 subjects each), born in Bandung City Regional Public Hospital. Serum creatinine level was tested by the Jaffe method. The estimated glomerular filtration rate was calculated based on serum creatinine, infant height, and a proportionality constant using the original Schwartz method, eGFR = [k * height]/SCr.

Results Of 32 subjects, there were 17 spontaneous deliveries, 14 males, and 18 females. Mean serum creatinine levels in the small-for-gestational age and appropriate-for-gestational age groups were 0.94 (SD 0.36; 95%CI 0.75 to 1.14) mg/dL and 0.69 (SD 0.18; 95%CI 0.60 to 0.79) mg/dL (mean difference 0.25; 95%CI 0.05 to 0.46; P=0.009), respectively. The median estimated glomerular filtration rates (eGFR) in the small-for-gestational age and appropriate-for-gestational age groups were 25.69 mL/min/1.73m2 and 30.10 mL/min/1.73m2 (median difference 4.42; 95%CI 2.04 to 15.8; P=0.008), respectively. There was a weak negative correlation between serum creatinine and birth weight (r=-0.344; P=0.027).

Conclusion Serum creatinine levels in small-for-gestational age newborns are significantly higher than in appropriate-for-gestational age newborns.


Mattoo TK. Neonatal acute kidney injury: pathogenesis, etiology, clinical presentation, and diagnosis. UpToDate [cited 2018 April 12] 2017. Available from:

Jetton JG, Askenazi DJ. Update on acute kidney injury in the neonate. Current opinion in pediatrics. 2012;24(2):191–6. PMid:22227783 PMCid:PMC5545784

Ottonello G, Dessì A, Neroni P, Trudu ME, Manus D, Fanos V. Acute kidney injury in neonatal age. J Pediatr Neonat Individual Med. 2014;3:e030246.

Selewski DT, Charlton JR, Jetton JG, Guillet R, Mhanna MJ, Askenazi DJ, et al. Neonatal acute kidney injury. Pediatrics. 2015;136:e463-73. PMid:26169430

Sarkar PD, Rajeshwari G, Shivaprakash TM. Cystatin C – a novel marker of glomerular filtration rate: a review. Indian J Clin Biochem. 2005;20:139-44. PMid:23105512 PMCid:PMC3454169

Reinhard M, Erlandsen EJ, Randers E. Biological variation of cystatin C and creatinine. Scand J Clin Lab Invest. 2009;69:831-6. PMid:19929276

Ronco C, Bellomo R, McCullough PA. Cardiorenal syndromes in critical care. Switzerland: Karger; 2010. p.346

Pottel H. Measuring and estimating glomerular filtration rate in children. Pediatr Nephrol. 2016;32:249–63. PMid:27115887

Walker MW, Clark RH, Spitzer AR. Elevation in plasma creatinine and renal failure in premature neonates without major anomalies: terminology, occurrence and factors associated with increased risk. J Perinatol. 2011;31:199–205. PMid:20651693

Zohdi V, Sutherland MR, Lim K, Gubhaju L, Zimanyi MA, Black MJ. Low birth weight due to intrauterine growth restriction and/or preterm birth: effects on nephron number and long-term renal health. Int J Nephrol. [cited 2018 April 20]. 2012; 2012:[13 p.]. Available from:

Russell BK. Babies who are small for gestational age. Pediatr Rev. 1995;16:354.

Lapillonne A, Braillon P, Claris O, Chatelain PG, Delmas PD, Salle BL. Body composition in appropriate and in small for gestational age infants. Acta Pædiatr. 1997;86:196–200. PMid:9055893

Finney H, Newman DJ, Thakkar H, Fell JM, Price CP. Reference ranges for plasma cystatin C and creatinine measurements in premature infants, neonates, and older children. Arch Dis Child. 2000;82:71–5. PMid:10630919 PMCid:PMC1718178

Vieux R, Hascoet JM, Merdariu D, Fresson J, Guillemin F. Glomerular filtration rate reference values in very preterm infants. Pediatrics. 2010;125:e1186–92. PMid:20368313

Meinardaniawati D, Effendi SH, Rahayuningsih SE. Kadar cystatin-C serum sebagai penanda fungsi ginjal bayi prematur. Sari Pediatri. 2013;15:17–22.

Wyss M, Kaddurah-Daouk R. Creatine and creatinine metabolism. Physiol Rev. 2000;80:1107–213. PMid:10893433

Avner ED, Harmon WE, Niaudet P, Yoshikawa N, Emma F. In: Goldstein SL, editor. Development of glomerular circulation and function/Glomerular hemodynamics and assessment of renal function. Pediatric nephrology. 7th ed. Berlin: Springer; 2016. p.46–53

Wagner C. Cystatin c, renal function and cardiovascular risk. JMB. 2008;27:426.

Schwartz GJ, Brion LP, Spitzer A. The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am. 1987;34:571–90.

Rao AY, Devabathina NB. Serum creatinine levels in first week of newborn infant - Influence of weight and gestational age: A prospective cohort study. IOSR-JDMS. 2017;16:68-83.

Ma-alich R, Reyes L, Herrera M, Melendi C, Fundora I. Relationship between weight at birth and the number and size of renal glomeruli in humans: a histomorphometric study. Kidney Int. 2000;58:770–3. PMid:10916101

Hinchliffe SA, Lynch MR, Sargent PH, Howard CV, Van Velzen D. The effect of intrauterine growth retardation on the development of renal nephrons. Br J Obstet Gynaecol. 1992;99:296–301. PMid:1581274

Holland P, Davies DP, Merlet-Benichou C, Leroy B, Gilbert T, Lelievre-Pegorier M. Placental insufficiency and its effect on the fetus and adult disease. Lancet. 1993;341:827–8.

Filler G, Yasin A, Medeiros M. Methods of assessing renal function. Pediatr Nephrol. 2014;29:183–92. PMid:23417278

Heilbron DC, Holliday MA, al-Dahwi A, Kogan BA. Expressing glomerular filtration rate in children. Pediatr Nephrol. 1991;5:5–11. PMid:2025537

Marsoosi V, Eslamian L, Jamal A, Fatehnejad M. Renal function assessment in newborns with intrauterine growth restriction. Ultrasound Obstet Gynecol. 2015;46:146–7.

Black MJ, Sutherland MR, Gubhaju L. Effects of preterm birth on the kidney. In: Sahay M, editor. Basic nephrology and acute kidney injury. Australia: InTech; 2012. p.62 PMid:21982034

Ballard J, Khoury J, Wedig K, Wang L, Eilers-Walsman B, Lipp R. New Ballard score, expanded to include extremely premature infants. J Pediatr. 1991;119:417–23.

Limawal F, Madjid DA, Daud D. The accuracy of determining newborn's maturity between New Ballard's score, Ballard's score, and first day of last menstrual period. Paediatr Indones. 2008;48:59–63.

Singhal R, Jain S, Chawla D, Guglani V. Accuracy of New Ballard Score in small-for-gestational age neonates. J Trop Pediatr. 2017;63:489–94. PMid:28977559

Ayyala VL, Devabathina N, Gurappagari P. Effect of gestational age and birth weight on serum creatinine in the first week of newborn life. Indian J Med Biochem. 2017;21:131–5.

How to Cite
Sandinirwan I, Primadi A, Hilmanto D. Serum creatinine levels to estimate kidney function in small-for-gestational age and appropriate-for-gestational age newborns. PI [Internet]. 17Dec.2018 [cited 31Mar.2023];58(6):305-1. Available from:
Received 2018-10-02
Accepted 2018-12-17
Published 2018-12-17