Acute Kidney Injury in the Newborn

Askenazi, David

doi:10.1007/978-3-642-39988-6_16

Cited by 2 publications

(3 citation statements)

References 83 publications

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“…The incidence of acute kidney injury (AKI) was determined using the Modified Neonatal Staging Criteria as previously described in the Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline for AKI. 19 20 21 22 23 We examined serum creatinine (SCr) measurements and daily UOP the day before NEC diagnosis, at NEC onset, at 24/48/72/96 hours after onset, and 1 week after NEC diagnosis. The maximum AKI stage reported was the highest SCr or UOP AKI stage 7 days after NEC onset.…”

Section: Methodsmentioning

confidence: 99%

Clinical Correlates of Moderate-to-Severe Bronchopulmonary Dysplasia in Preterm Infants following Surgical Necrotizing Enterocolitis

et al. 2022

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Objective: To determine clinical correlates of moderate to severe bronchopulmonary dysplasia (BPD) in preterm infants following surgical necrotizing enterocolitis (NEC). Methods: A retrospective, single-center cohort study comparing patients with moderate to severe BPD to patients with non/mild BPD among surgical NEC infants. BPD was defined by NIH 2001 consensus definition Results: Of 92 consecutive neonates with surgical NEC, 77% (71/92) had moderate/severe BPD and 22% (21/92) had non/mild BPD. The patent ductus arteriosus (PDA) was significantly higher in those developing moderate/severe BPD (67.6% [48/71]) than non/mild BPD (28.6% [6/21]; p=0.001). Postoperatively,infants with moderate/severe BPD had more severe AKI (67.6% [48/71] vs. 28.6% [6/21]; p=0.001), were intubated longer (40.5 days [IQR 12, 59] vs. 6 days [IQR 2, 13]; p<0.001), received more parenteral nutrition (109 days [IQR 77, 147] vs. 55 days [IQR 19, 70]; p<0.001), developed higher surgical morbidity (46.5% [33/71] vs. 14.3% [3/21]; p=0.008), had more intestinal failure (62.5% vs. 13.3%; p<0.001), required a longer hospital stay (161 days [IQR 112, 186] vs. 64 days [IQR 20, 91]; p<0.001), and were more likely to need home oxygen. In a multivariable analysis, lower birth weight (OR=0.3, [95% CI 0.1-0.5]; p=0.001), patent ductus arteriosus (OR=10.3, [95%CI 1.6-65.4]; p=0.014) and longer parenteral nutritional days (OR=8.8; [95%CI 2.0 -43.0]; p=0.005) were significantly and independently associated with higher odds of moderate/severe vs. non/mild BPD. Conclusion: Development of moderate/severe BPD occurred in the majority of preterm infants with surgical NEC in this consecutive series. Preterm infants with moderate/severe BPD were more likely to have a PDA before NEC. Development of moderate/severe BPD was associated with significantly greater burden and duration of post-operative morbidity following surgical NEC. Identifying surgical NEC infants at increased risk of moderate/severe BPD and developing lung protection strategies may improve surgical NEC outcomes.

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Section: Methodsmentioning

confidence: 99%

Clinical Correlates of Moderate-to-Severe Bronchopulmonary Dysplasia in Preterm Infants following Surgical Necrotizing Enterocolitis

et al. 2022

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“…In our cohort study 18 of 202 neonates with NEC (Bell stage > IIa), the Modified Neonatal Staging Criteria described in the Kidney Disease: Improving Global Outcomes Clinical Practice Guideline for AKI was used to determine the incidence of kidney injury. 13 14 19 20 21 In this manner, severe AKI occurred in 66/202 (32.6%) neonates after NEC diagnosis and in 61/104 (58.7%) after surgical NEC diagnosis. Using adjusted logistic regression modeling, surgical NEC, birth at outside facility, exposure to antenatal steroids, and blood culture-proven sepsis was associated with higher odds for severe AKI.…”

mentioning

confidence: 77%

“…12 These hemodynamic changes combined with surgical stresses, anesthetic agents, and nephrotoxic medications are associated with AKI. 13…”

mentioning

confidence: 99%

Necrotizing Enterocolitis-Associated Acute Kidney Injury—Transforming the Paradigm

Garg,

Shenberger,

South

et al. 2024

Am J Perinatol

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Necrotizing enterocolitis (NEC) is one of the most common conditions requiring emergency surgery in the neonatal intensive care unit and is associated with a septic shock-like state contributing to multi-organ dysfunction. NEC affects 6-10% of very-low birth-weight infants and remains a leading cause of death. The occurrence of severe AKI following surgical NEC is a harbinger of multiple morbidities. This review presents current evidence about the clinical impact of NEC associated AKI on the clinical outcomes. Studies evaluating nephro-protective strategies to prevent AKI and its consequences are greatly needed to improve the post-operative recovery and clinical outcomes in neonates with NEC. Future observational studies and clinical trials in preterm-born infants with NEC prioritize measuring short-term (AKI) and longer term (chronic kidney disease) kidney outcomes. Impact: 1. Severe AKI (stage 2 and 3) occurs in 32.6% of neonates after NEC diagnosis and in 58.7% following surgical NEC diagnosis. 2. NEC associated AKI is associated with severe postoperative course, moderate to severe bronchopulmonary dysplasia, surgical complications, brain injury and longer hospital stay in preterm infants. 3. Severity of NEC associated AKI can be utilized by bedside providers for the prognostication of clinical outcomes in preterm infants.

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Acute Kidney Injury in the Newborn

Cited by 2 publications

References 83 publications

Clinical Correlates of Moderate-to-Severe Bronchopulmonary Dysplasia in Preterm Infants following Surgical Necrotizing Enterocolitis

Clinical Correlates of Moderate-to-Severe Bronchopulmonary Dysplasia in Preterm Infants following Surgical Necrotizing Enterocolitis

Necrotizing Enterocolitis-Associated Acute Kidney Injury—Transforming the Paradigm

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