BackgroundSingle-center studies suggest that neonatal acute kidney injury (AKI)
is associated with poor outcomes. However, inferences regarding the
association between AKI, mortality, and hospital length of stay are limited
due to the small sample size of those studies. In order to determine whether
neonatal AKI is independently associated with increased mortality and longer
hospital stay, we analyzed the Assessment of Worldwide Acute Kidney
Epidemiology in Neonates (AWAKEN) database.MethodsAll neonates admitted to 24 participating neonatal intensive care
units from four countries (Australia, Canada, India, United States) between
January 1 and March 31, 2014, were screened. Of 4273 neonates screened, 2022
(47·3%) met study criteria. Exclusion criteria included: no
intravenous fluids ≥48 hours, admission ≥14 days of life,
congenital heart disease requiring surgical repair at <7 days of life,
lethal chromosomal anomaly, death within 48 hours, inability to determine
AKI status or severe congenital kidney abnormalities. AKI was defined using
a standardized definition —i.e., serum creatinine rise of
≥0.3 mg/dL (26.5 mcmol/L) or ≥50% from previous
lowest value, and/or if urine output was <1 mL/kg/h on postnatal days 2
to 7.FindingsIncidence of AKI was 605/2022 (29·9%). Rates varied
by gestational age groups (i.e., ≥22 to <29 weeks
=47·9%; ≥29 to <36 weeks
=18·3%; and ≥36 weeks
=36·7%). Even after adjusting for multiple potential
confounding factors, infants with AKI had higher mortality compared to those
without AKI [(59/605 (9·7%) vs. 20/1417
(1·4%); p< 0.001; adjusted OR=4·6
(95% CI=2·5–8·3);
p=<0·0001], and longer hospital stay
[adjusted parameter estimate 8·8 days (95%
CI=6·1–11·5);
p<0·0001].InterpretationNeonatal AKI is a common and independent risk factor for mortality
and longer hospital stay. These data suggest that neonates may be impacted
by AKI in a manner similar to pediatric and adult patients.FundingUS National Institutes of Health, University of Alabama at
Birmingham, Cincinnati Children’s, University of New Mexico.
In the last decade, it has become increasingly clear that necrotizing enterocolitis (NEC) is neither a uniform nor a well-defined disease entity. There are many factors that are forcing this unwelcome realization upon the neonatal and pediatric surgery communities. In the course of this manuscript we will review the history and the physical findings of the disparate etiologies of acquired neonatal intestinal diseases (ANIDs), some which do lead to the common final pathology of NEC and some which do not. New guidelines for distinguishing between ANIDs will also be suggested. (2007) Keywords: necrotizing enterocolitis; spontaneous intestinal perforation; neonate; intestine; premature; diagnosis A brief history of clinical NEC research in the presurfactant era During the late 1970s, necrotizing enterocolitis (NEC) was most commonly seen in preterm infants >30 weeks of gestation.
Journal of Perinatology
AKI occurred in 40% of very low birth weight infants and was concentrated in the most premature and severely ill infants. One in six infants experienced multiple episodes of AKI, and a small number of infants was discharged with an elevated serum creatinine. Reporting a history of AKI in the discharge summary occurred infrequently, and referral to a nephrologist for AKI follow-up did not occur, highlighting areas for quality improvement.
Although the COVID-19 pandemic has largely not clinically affected infants in neonatal intensive care units around the globe, it has affected how care is provided. Most hospitals, including their NICUs, have significantly reduced parental and family visitation privileges. From an ethical perspective, this restriction of parental visitation in settings where infectious risk is difficult to understand. No matter what the right thing to do is, NICUs are currently having to support families of their patients via different mechanisms. In this perspective, we discuss ways NICUs can support parents and families when they are home and when they are in the NICU as well as provide infants the support needed when family members are not able to visit.
BACKGROUND:
Exogenous surfactants to treat respiratory distress syndrome (RDS) are approved for tracheal instillation only; this requires intubation, often followed by positive pressure ventilation to promote distribution. Aerosol delivery offers a safer alternative, but clinical studies have had mixed results. We hypothesized that efficient aerosolization of a surfactant with low viscosity, early in the course of RDS, could reduce the need for intubation and instillation of liquid surfactant.
METHODS:
A prospective, multicenter, randomized, unblinded comparison trial of aerosolized calfactant (Infasurf) in newborns with signs of RDS that required noninvasive respiratory support. Calfactant was aerosolized by using a Solarys nebulizer modified with a pacifier adapter; 6 mL/kg (210 mg phospholipid/kg body weight) were delivered directly into the mouth. Infants in the aerosol group received up to 3 treatments, at least 4 hours apart. Infants in the control group received usual care, determined by providers. Infants were intubated and given instilled surfactant for persistent or worsening respiratory distress, at their providers’ discretion.
RESULTS:
Among 22 NICUs, 457 infants were enrolled; gestation 23 to 41 (median 33) weeks and birth weight 595 to 4802 (median 1960) grams. In total, 230 infants were randomly assigned to aerosol; 225 received 334 treatments, starting at a median of 5 hours. The rates of intubation for surfactant instillation were 26% in the aerosol group and 50% in the usual care group (P < .0001). Respiratory outcomes up to 28 days of age were no different.
CONCLUSIONS:
In newborns with early, mild to moderate respiratory distress, aerosolized calfactant at a dose of 210 mg phospholipid/kg body weight reduced intubation and surfactant instillation by nearly one-half.
VLBW infants are frequently exposed to nephrotoxic medications, receiving approximately two weeks of nephrotoxic medications before discharge or 1 for every 6 d of hospitalization. The greatest exposure occurred among the smallest, most immature infants and those who experienced AKI.
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