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 endemic areas, paediatricians should have a low threshold of suspicion for perinatal or neonatal chikungunya in any infant presenting with signs and symptoms mimicking sepsis, especially with skin manifestations, seizure and/or encephalopathy.
Using phase changing material based cooling device and a standard protocol, it was feasible and safe to provide therapeutic hypothermia to asphyxiated neonates across different neonatal units in India. Maintenance of target temperature was comparable to standard servo-controlled equipment.
Worldwide, thousands of cases of multisystem inflammatory syndrome in children (MIS-C) have already been reported in children. Evidence regarding neonatal MIS-C is limited. We present the first case report of a neonate presenting within 48 hours of life with predominant abdominal signs mimicking surgical abdomen. Clinical picture comprised fever, multiorgan dysfunction (gastrointestinal, cardiorespiratory, hepatic and dermatological), positive inflammatory markers, high ferritin and high D-dimer levels. Cardiac enzyme N-terminal-pro-B-type natriuretic peptide as well as D-dimer levels were elevated. Blood, urine, stool and cerebrospinal fluid cultures were sterile. Positive anti-SARS-CoV-2 IgG in both the mother and the infant, along with an epidemiological evidence of maternal contact with COVID-19, clinched the diagnosis of MIS-C. Immunomodulatory drugs (intravenous immunoglobulin and systemic steroids) were administered and showed good clinical response. A high index of suspicion of MIS-C in critically ill neonates can improve outcomes.
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