Acute kidney injury in preterm infants admitted to a neonatal intensive care unit

Stojanović, Vesna; Barišić, Nenad; Milanović, Borko; Doronjski, Aleksandra

doi:10.1007/s00467-014-2837-0

Cited by 72 publications

(68 citation statements)

References 34 publications

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“…Sepsis has been consistently shown to be a risk factor for the development of AKI across neonatal populations, contributing to up to 78% of the cases of AKI. [51][52][53][54] Mathur et al 55 described 200 term neonates with sepsis of whom 52 developed AKI. Those who developed AKI had a lower birth weight and were more likely to have meningitis, disseminated intravascular coagulation, and septic shock.…”

Section: Sepsismentioning

confidence: 99%

Neonatal Acute Kidney Injury

et al. 2015

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In recent years, there have been significant advancements in our understanding of acute kidney injury (AKI) and its impact on outcomes across medicine. Research based on single-center cohorts suggests that neonatal AKI is very common and associated with poor outcomes. In this state-of-the-art review on neonatal AKI, we highlight the unique aspects of neonatal renal physiology, definition, risk factors, epidemiology, outcomes, evaluation, and management of AKI in neonates. The changes in renal function with gestational and chronologic age are described. We put forth and describe the neonatal modified Kidney Diseases: Improving Global Outcomes AKI criteria and provide the rationale for its use as the standardized definition of neonatal AKI. We discuss risk factors for neonatal AKI and suggest which patient populations may warrant closer surveillance, including neonates ,1500 g, infants who experience perinatal asphyxia, near term/ term infants with low Apgar scores, those treated with extracorporeal membrane oxygenation, and those requiring cardiac surgery. We provide recommendations for the evaluation and treatment of these patients, including medications and renal replacement therapies. We discuss the need for long-term follow-up of neonates with AKI to identify those children who will go on to develop chronic kidney disease. This review highlights the deficits in our understanding of neonatal AKI that require further investigation. In an effort to begin to address these needs, the Neonatal Kidney Collaborative was formed in 2014 with the goal of better understanding neonatal AKI, beginning to answer critical questions, and improving outcomes in these vulnerable populations.

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Section: Sepsismentioning

confidence: 99%

Neonatal Acute Kidney Injury

et al. 2015

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“…553 Acute kidney injury in preterm neonates is associated with high mortality. 554 Hepatic injury and dysfunction are frequent associations with severe sepsis. The mechanisms include reduced hepatic perfusion associated with septic shock and mitochondrial energy failure.…”

Section: Other Organ System Contributionsmentioning

confidence: 99%

Pathophysiology of Neonatal Sepsis

Wynn¹,

Wong²

2017

Fetal and Neonatal Physiology

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“…We defined HS PDA as more than 2 mm in ductal diameter plus predominant left to right flow on echocardiography initially performed at average postnatal day 7; requiring ventilator support accompanying signs and symptoms consistent with symptomatic PDA, such as hypotension with mean airway pressure below GA; grade ≥ 2 cardiac murmur; pulse pressure widening (>30 mmHg); or need for increased respiratory support [31,32]. We deferred until postnatal day 7 as spontaneous ductal closures could occur even in EPT for the first postnatal week [17,34]. Follow-up echocardiography was conducted regularly at 2-4 weeks intervals until PDA closure.…”

Section: Hs Pdamentioning

confidence: 99%

“…AKI in premature infants are known to be related to increased mortality [11,[17][18][19][20][21] and morbidities, which includes bronchopulmonary dysplasia (BPD) [2,22,23] and intraventricular hemorrhage (IVH) [24]. However, these associations have not been well reported and elucidated in EPT, although J. Clin.…”

Section: Introductionmentioning

confidence: 99%

“…2020, 9, 699 2 of 10 EPT are at high risk for acute AKI because of low GFR resulting from under-developed kidney systems, exhibiting incomplete nephrogenesis and low nephron number [25,26]. Meanwhile, hemodynamically significant (HS) patent ductus arteriosus (PDA) could promote developing AKI by decreasing renal perfusion in the preterm infants in recent studies [16,17,[27][28][29]. However, growing evidences support that the conservative management of HS PDA could be safe and feasible without increased mortality and/or morbidities [30][31][32][33].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Changes in Serum Creatinine Levels and Natural Evolution of Acute Kidney Injury with Conservative Management of Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants at 23–26 Weeks of Gestation

Seo

Sung

Ahn

et al. 2020

JCM

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Changes in kidney function in extremely preterm infants (EPT) with conservatively managed hemodynamically significant (HS) patent ductus arteriosus (PDA) are not known well. We aimed to present the postnatal course in serum creatinine levels (sCr), prevalence of acute kidney injury (AKI), then relevance between AKI and adverse outcomes in EPT with conservatively managed HS PDA. By review of medical records, we analyzed the postnatal course of sCr and prevalence of stage 3 AKI defined by the modified Kidney Disease Improving Global Outcome (KDIGO) in EPT at gestational age of 23 to 26 weeks with conservatively treated HS PDA. We investigated if the presence and/or prolonged duration of stage 3 AKI elevated the risk of adverse outcomes. The results showed that, neither factor was associated with adverse outcomes. While the average PDA closure date was at postnatal day (P) 41 and 53, sCr peaked at P 10 and 14 and the cumulative prevalence of stage 3 AKI was 57% and 72% in the EPT of 25-26 and 23-24 weeks' gestation, respectively. The high prevalence of stage 3 AKI without adverse outcomes in EPT with conservatively managed HS PDA suggests that it might reflect renal immaturity rather than pathologic conditions.

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Acute kidney injury in preterm infants admitted to a neonatal intensive care unit

Abstract: AKI is associated with high mortality in preterm neonates. It is very important to identify, as quickly as possible, all infants who are at high risk of developing AKI.

Cited by 72 publications

References 34 publications

Neonatal Acute Kidney Injury

Neonatal Acute Kidney Injury

Pathophysiology of Neonatal Sepsis

Changes in Serum Creatinine Levels and Natural Evolution of Acute Kidney Injury with Conservative Management of Hemodynamically Significant Patent Ductus Arteriosus in Extremely Preterm Infants at 23–26 Weeks of Gestation

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