Acute Kidney Injury in Newborns

Abstract

Objective: Acute kidney injury is common condition in the neonatal intensive care unit and it is associated with poor outcome. The incidence of neonatal AKI is the highest one followed by adults and children, depending on different factors such as the gestational age, birth weight, contributing conditions and the facilities of the neonatal intensive care unit. The aim of the study was to determine the incidence, risk factors and the outcome of the neonatal acute kidney injury. Subjects and Methods: This was a clinical, prospective study that was performed in a referent NICU at the University Children's Hospital in Skopje. All neonates admitted from January 2012 to December 20014 with documented acute kidney injury were included. The medical data records of the admitted neonates with AKI were analyzed. The material was statistically processed using methods of the descriptive statistics. Results: During the study period 770 newborn infants were admitted to the NICU and 50 (6.5%) infants developed acute kidney injury. The male to female ratio was 2.1:1. Most of the neonates involved in the study were neonates born at term (62%). Oliguric AKI was found in 28 cases (56%) and no oliguric in 22 cases (44%). The prevalence of prerenal, renal and post renal AKI were 78.5%, 19.5% and 2.0% respectively. Perinatal asphyxia was the most common predisposing factor for AKI and was evaluated in 38% of the cases with predominance of term infants and male. The mortality rate was 32% and was significantly higher in the group of patients with congenital heart diseases. Conclusion: AKI is a life threatening condition with still high mortality rate. Early recognition of the risk factors and the rapid effective treatment of the contributing conditions will reduce AKI in the neonatal period.

Associated factors for acute kidney injury in preterm infants

“…In the present study, the rate of PTNB with AKI was 7.5%, a value that is similar to most international studies that indicate a prevalence of AKI in neonates, ranging from 6.3% to 8.4% (7)(8)11,14) . It is worth mentioning that the great majority of the investigations that investigated the presence of AKI in the neonatal population did so without classifying the NB according to gestational age.…”

“…AKI is a multifactorial pathology of origin, whose origin in preterm newborns (PTNB) is related to numerous risk factors, including low birth weight (<2,500 g) (10) , low Apgar score, intubation at birth, respiratory distress syndrome, cardiac congestion, congenital anomalies (11) , administration of certain medicines (12) , persistent ductus arteriosus, neonatal sepsis, shock (7) , hyperbilirubinemia (13) , surgical interventions (14) , renal anomalies, among others (9) .…”

“…Studies show that AKI develops in approximately 8 to 24% of all infants admitted to the Neonatal Intensive Care Unit (NICU), and mortality rates can reach between 14 and 73% of cases (10)(11)13) .…”

Neonatal Kidney Dimensions and Medullary Pyramid Thicknesses According to the Weight, Length and Body Mass Index of Newborns

“…Acute kidney damage (AKD) is a common disorder and often has a severe outcome in neonatal intensive care units. The incidence of AKD in newborns is related to the gestational week, birth weight, postnatal weight and the facilities of the neonatal intensive care unit which affects the prognosis (7). Such diseases can affect renal morphology and size by causing parenchymal atrophy or hypertrophy.…”

Clinical Utility of Rapid Plasma Neutrophil Gelatinase-Associated Lipocalin Assays for Diagnosing Acute Kidney Injury in Critically Ill Newborn Infants

“…It is frequently found in infants in the neonatal intensive care unit (NICU), with poor outcome associated with increased length of stay and mortality 2) . Critically ill infants in the NICU are at a high risk of having AKI because they have multiple risk factors [3][4][5] .…”