Diuretic therapy and acute kidney injury in preterm neonates and infants

Mohamed, Tahagod; Klamer, Brett; Mahan, John D.; Spencer, John David; Slaughter, Jonathan L.

doi:10.1007/s00467-021-05132-6

Cited by 10 publications

(7 citation statements)

References 19 publications

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“…Diuretics are usually given as a treatment option for AKI in neonates due to the lack of appropriately-sized kidney support therapy devices, especially for those with smaller body weight, therefore, diuretics are the mainstay therapy. 26 We found that the uNGAL/Cr ratio was inversely related to gestational age and birth weight in VPN. As reported in a previous study, gestational age was the only parameter affecting uNGAL/Cr ratio in a mixed model regression analysis compared to other parameters, such as sex, race, prevalence of AKI, and insertion of an umbilical artery catheter.…”

Section: Discussionmentioning

confidence: 61%

“…20 In our study, 10.2% of VPN received diuretic (furosemide) treatment, whereas a previous study across 46 US children's hospitals reported 17.9% use of diuretics in preterm neonates. 26 Participants who received diuretics had higher median uNGAL/Cr ratio at 72 hours and 21 days (Table 2). Diuretics are usually given as a treatment option for AKI in neonates due to the lack of appropriately-sized kidney support therapy devices, especially for those with smaller body weight, therefore, diuretics are the mainstay therapy.…”

Section: Discussionmentioning

confidence: 99%

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Does protein intake correlate with tubular function in very preterm neonates?

Puspitasari,

Trihono,

Wahidiyat

2023

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Background High protein intake in very preterm neonates (VPN) is important for growth. However, preterm kidneys have fewer functional nephrons and many of the ones present may be immature. Studies have shown that high protein intake induces nephron hypertrophy, proteinuria, and glomerular sclerosis, which lead to tubular injury. Urinary neutrophil gelatinase-associated lipocalin (uNGAL) is a biomarker that is released during proximal tubular cell injury. The uNGAL to creatinine (uNGAL/Cr) ratio is commonly performed for normalization. Objective To assess for a possible association between protein intake and uNGAL/Cr ratio in VPN. Methods A prospective cohort study was conducted in two NICUs in Jakarta. Subjects’ urine specimens were collected at 0-48 hours, 72 hours, and 21 days after birth to determine uNGAL/Cr ratio as a biomarker of tubular injury. Protein was administered according to study sites NICU guidelines. Protein intake was recorded daily from 14-21 days of age for formula and measured twice with a human milk analyzer for breast milk. ELISA was used to measure uNGAL concentration. Low protein intake was defined as <3g/kg/day and high protein intake was defined as ?3g/kg/day. Maternal and perinatal variables were recorded from medical records. Results Fifty-nine VPN were recruited, of whom 39 completed the study. Median uNGAL/Cr ratio ranged from 0.32-104.11 ng/mg. The uNGAL/Cr ratio was not correlated with protein intake but was inversely correlated with gestational age and birth weight [r = -0.320, P=0.019 for the 72-hr (T2) urinary collection]. Higher uNGAL/Cr levels were associated with maternal infection [14.4 (range 4.4-104.1) vs 7.2 (range 0.5–32.4) ng/mg, P=0.004 at the 0-48-hr (T1)], maternal anemia [6.9 (range 1.2–66.6) vs 1.7 (range 0.3–89.2) ng/mg, P=0.001 at the 21-day (T3)] and nephrotoxic medication [15.9 (range 1.3–63.8) vs 1.0 (range 0.4–8.6) ng/mg, P=0.026 at the 72-hr]. Conclusion Protein intake according to current nutritional guidelines does not correlate with tubular injury in VPN, as measured by uNGAL/Cr ratio. Maternal infection, maternal anemia, lower birth weight, and nephrotoxic medication, were associated with higher uNGAL/Cr levels in VPN.

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Section: Discussionmentioning

confidence: 61%

Section: Discussionmentioning

confidence: 99%

Does protein intake correlate with tubular function in very preterm neonates?

Puspitasari,

Trihono,

Wahidiyat

2023

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“…In our study, the prevalence of perioperative AKI is higher compared to the general prevalence of AKI in the PHIS database during the same study period. We previously found that neonatal AKI occurs in 1-3% of neonates admitted to a participating NICU when ICD codes are used to identify AKI in PHIS and those rates are lower than what was previously reported in the literature using serum creatinine AKI criteria [18][19][20].…”

Section: Discussionmentioning

confidence: 70%

“…We previously found that neonatal AKI occurs in 1 to 3% of neonates admitted to a participating neonatal intensive care unit (NICU) when ICD codes are used to identify AKI in PHIS and those rates are lower than what was previously reported in the literature using serum creatinine AKI criteria. [18][19][20] Risk factors of AKI in critically ill neonates have been described in multicenter studies, 8 however, the risks and comorbidities associated with perioperative neonatal AKI are less defined and mostly reliant on single-center reports.…”

Section: Discussionmentioning

confidence: 99%

Perioperative Neonatal Acute Kidney Injury Is Common: Risk Factors for Poor Outcomes

Mohamed,

Mpody,

Nafiu

2023

Am J Perinatol

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Objective Perioperative acute kidney injury (AKI) is associated with poor patient outcomes. The epidemiology of perioperative AKI is characterized in children and to a lesser extent in neonates with cardiac disease. We hypothesized that the prevalence of noncardiac perioperative AKI in neonates is higher than in older children. We also hypothesized that certain neonatal characteristics and comorbidities increase the risk of perioperative AKI and hospital mortality. We aimed to characterize the epidemiology and risk factors of perioperative AKI in neonates undergoing noncardiac surgeries and outline the associated mortality risk factors. Study Design We performed a retrospective study of neonates ≤28 days old who underwent inpatient noncardiac surgery in 46 U.S. children's hospitals participating in the Pediatric Hospital Information System between 2016 and 2021. AKI was evaluated throughout the surgical admission encounter. AKI was defined using the International Classification of Diseases (ICD) versions 9 and 10 codes. Comorbid risk factors are chronic and longstanding diagnoses and were selected using ICD-9 and ICD-10 diagnostic and procedure codes. Results Perioperative AKI occurred in 10% of neonates undergoing noncardiac surgeries. Comorbidities associated with high risk of perioperative AKI included metabolic, hematologic/immunologic, cardiovascular, and renal disorders. The relative risk of mortality in perioperative AKI was highest in infants with low birthweight (relative risk = 1.49, 1.14–1.94) and those with hematologic (1.46, 1.12–1.90), renal (1.24, 1.01–1.52), and respiratory comorbidities (1.35, 1.09–1.67). Conclusion Perioperative AKI is common in neonates undergoing noncardiac surgeries. Infants with high-risk comorbidity profiles for the development of perioperative AKI and mortality may benefit from close surveillance of their kidney function in the perioperative period. Although retrospective, the findings of our study could inform clinicians to tailor neonatal perioperative kidney care to improve short- and long-term outcomes. Key Points

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“…Mechanical ventilation (MV) is necessary when ill preterm neonates are treated. It is usually using for a short time, but in some cases may be used for a long period, which was linked with adverse health effects and impaired long-term respiratory and developmental outcomes (Mohamed et al, 2021). Weaning from the MV is usually achieved by gradually decreasing of the ventilator support level until the settings are reduced to remove support.…”

Section: Introductionmentioning

confidence: 99%

Effect of Right lateral Position on Blood Oxygenation of Premature Infants after Weaning from Mechanical Ventilation

Abdel-Nazeer

Ahmed²,

AbdelAziz³

et al. 2023

Assiut Scientific Nursing Journal

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Background:Positioning is an important tool to improve the efficiency of respiratory function and it is one of the important nursing duties. Aim: of this study was to assess effect of right lateral position on oxygenation of premature infants after weaning from mechanical ventilation. Research design: A quasi-experimental research design was used Subjects and Setting: A convenient 60 premature infants within 2 hours after weaning from the mechanical ventilation were included in the study in neonatal intensive care unit (NICU) at Assiut University Children Hospital. They divided to two groups (the control and the study) Tools: Two tools were developed to collect data of the present study. Results: At the end of the 6 th 20 minutes after weaning from mechanical ventilators mean ± SD SaO 2 (%) of premature infants in the right lateral position was (95.90 ± 1.95) compared by (92.27 ± 2.41) among Premature infants in the control group. Statistically significant differences were found between the two groups related their PH, and respiratory rate. Conclusion: Premature infants placed on the right lateral position had higher SaO 2 (%) and lower complications as breathing difficulty and /or apnea than others. Recommendations: Right lateral position should be used in the routine care of infants weaning from mechanical ventilation.

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Diuretic therapy and acute kidney injury in preterm neonates and infants

Cited by 10 publications

References 19 publications

Does protein intake correlate with tubular function in very preterm neonates?

Does protein intake correlate with tubular function in very preterm neonates?

Perioperative Neonatal Acute Kidney Injury Is Common: Risk Factors for Poor Outcomes

Effect of Right lateral Position on Blood Oxygenation of Premature Infants after Weaning from Mechanical Ventilation

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