Improving the identification of acute kidney injury in the neonatal ICU: three centers’ experiences

Abstract

Objective: To describe 3 different standardized approaches to improving neonatal acute kidney injury (AKI) identification and the impact on AKI identification, incidence, and nephrology consultation and referral.Study Design: Retrospective cohort study in three academic NICUs. We compared AKI identification, AKI incidence, nephrology consultation and nephrology follow-up before and after implantation of local protocols to standardized neonatal AKI identification.Result: Neonatal AKI identification improved in all three NICUs following protocol implementation (26% to 85%, P<0.0001). Each center also saw increases in nephrology consultation (15% to 83%, P<0.0001) and nephrology follow-up (7% to 73%, P<0.0001). AKI incidence decreased significantly (21% to 12%, P<0.0001). Conclusion:Multiple strategies can be successfully operationalized to improve neonatal AKI identification. While different in approach, each strategy resulted in increased AKI identification and nephrology involvement. This study emphasizes the importance of local standardized approaches to AKI to improve AKI identification and nephrology involvement in the NICU.

Acute kidney injury surveillance in the high‐risk neonatal population following implementation of creatinine screening protocol

“…14,16,17 A recent multicentre study has similarly demonstrated that sCr protocol screening strategies can improve identification of AKI events in the NICU. 10 The rate of AKI in this study falls within the AKI incidence range reported in other studies, though it was lower than the overall rate of AKI in the AWAKEN study. 1,4,14 AKI detection rates may have been higher had we continued to analyse sCr data after 36 weeks PMA.…”

“…Another multicentre study evaluated different approaches to AKI screening protocols across three academic NICUs and found that each approach was associated with a significant improvement in AKI identification and increased nephrology consultation. 10 After implementation of protocols for identification and management of AKI, clinician diagnosis and recognition of AKI increased from 26% (49/187) to 85% (103/121). 10 Overall, this study suggests there may be multiple successful screening strategies for improving AKI diagnosis and identification.…”

“…10 After implementation of protocols for identification and management of AKI, clinician diagnosis and recognition of AKI increased from 26% (49/187) to 85% (103/121). 10 Overall, this study suggests there may be multiple successful screening strategies for improving AKI diagnosis and identification. However, the optimal methods or protocols to improve AKI detection remain unknown.…”

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

“…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].…”

“…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.…”