Neonatal Acute Kidney Injury

Coleman, Cassandra; Perez, Anita Tambay; Selewski, David T.; Murphy, Heidi J

doi:10.3389/fped.2022.842544

Cited by 46 publications

(41 citation statements)

References 99 publications

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“… 5 , 6 , 7 , 8 , 9 Short-term mortality risk and long-term kidney complications, including hypertension, are associated with neonatal AKI. 10 …”

Section: Introductionmentioning

confidence: 99%

“… 11 Using these criteria, the prevalence and severity of AKI as well as the association of AKI with outcomes of interest in different neonatal populations and at different times after birth have been characterized. 10 A secondary analysis of a large cohort of ELBWs, who have the greatest risk of AKI among NICU patients, showed that stage 3 AKI (most severe) may portend subsequent mortality based on sCr concentration measurements collected as part of standard clinical care. 5 However, that study did not include longitudinal measures of organ dysfunction or shock.…”

Section: Introductionmentioning

confidence: 99%

“…[5][6][7][8][9] Short-term mortality risk and long-term kidney complications, including hypertension, are associated with neonatal AKI. 10 Neonatal AKI is commonly defined using age-modified Kidney Disease: Improving Global Outcomes (KDIGO) criteria wherein the severity is determined by the magnitude of changes in serum creatinine (sCr Δ ) concentration or urine output (UOP). 11 Using these criteria, the prevalence and severity of AKI as well as the association of AKI with outcomes of interest in different neonatal populations and at different times after birth have been characterized.…”

Section: Introductionmentioning

confidence: 99%

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Frequency of Acute Kidney Injury and Association With Mortality Among Extremely Preterm Infants

et al. 2022

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ImportanceNeonatal acute kidney injury (AKI) is common and associated with morbidity and mortality. The temporal relationship between AKI and critical illness, as well as the frequency of AKI definition components (urine output and serum creatinine [sCr] concentration change), are unknown in extremely low-birth-weight (ELBW) (&lt;1000 g), extremely preterm (&lt;29 weeks’ completed gestational age [GA]) infants.ObjectiveTo measure the frequency of AKI from birth to death or discharge with attention to the definition components as well as the temporal relationship of AKI to critical illness and death.Design, Setting, and ParticipantsA single-center, multiyear, retrospective cohort study was conducted at an academic level IV neonatal intensive care unit between January 1, 2012, and January 1, 2020. Participants included inborn ELBW and infants at 22 to 28 weeks’ completed GA with confirmed congenital anomalies who survived 12 hours or more.ExposuresExtremely preterm birth and ELBW.Main Outcomes and MeasuresThe primary outcome was AKI frequency. The timing, severity, and criteria for AKI were measured. The temporal relationship between AKI, organ dysfunction, and outcomes were quantified using odds ratios (ORs), logistic regression, and Shapley Additive Explanations. Acute kidney injury recognition, imaging, pediatric nephrology consultation, and follow-up were determined.ResultsA total of 436 infants (52% male; 44% Black) met the inclusion criteria (median BW, 725 g; median GA, 25.7 wk). Acute kidney injury was common in the first week of life (44%), primarily based on the change in the sCr concentration criterion (88%), and negatively associated with GA (OR, 0.69; 95% CI, 0.60-0.78), but positively associated with antecedent critical illness (OR, 1.17; 95% CI, 1.12-1.23), severe intraventricular hemorrhage (OR, 1.86; 95% CI, 1.12-3.08), late-onset sepsis (OR, 1.03; 95% CI, 1.02-1.03), and mortality (OR, 2.77; 95% CI, 1.63-4.72). Acute kidney injury had negligible clinical contribution to death within the model (Shapley Additive Explanation, &lt;0.5% change to outcome) relative to antecedent patient-concentration organ dysfunction (6%-15% change). Among infants with severe AKI, recognition (32%), nephrology inpatient consultation (16%), and outpatient follow-up (9%) were not common.Conclusions and RelevanceIn this cohort study of ELBW infants, AKI was common in the first week of life, inversely associated with GA, and followed organ (primarily cardiovascular) dysfunction. Acute kidney injury considered as the primary pathway to mortality was rare, and amelioration of AKI to modify death was not well supported.

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“… 5 , 6 , 7 , 8 , 9 Short-term mortality risk and long-term kidney complications, including hypertension, are associated with neonatal AKI. 10 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Frequency of Acute Kidney Injury and Association With Mortality Among Extremely Preterm Infants

et al. 2022

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“…According to the Neonatal Kidney Disease Improving Global Outcome (NKDIGO) criteria, the definition of neonatal AKI is currently based on two markers: serum creatinine (SCr) levels increase from a baseline steady state or reduced UO 10 11. Some limitation exists to use SCr in neonates due to the lack of baseline steady-state SCr in critically ill preterm neonates.…”

Section: Introductionmentioning

confidence: 99%

Early urine output monitoring in very preterm infants to predict in-hospital neonatal outcomes: a bicentric retrospective cohort study

Mul¹,

Héneau

Biran

et al. 2023

BMJ Open

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ObjectiveTo evaluate whether urine output (UO), rarely assessed in the literature, is associated with relevant neonatal outcomes in very preterm infants, and which UO threshold may be the most clinically relevant.DesignRetrospective cohort study.SettingTwo Level IV neonatal intensive care units.PatientsVery preterm infants born between 240/7and 296/7weeks of gestation documented with eight UO measurements per day between postnatal day 1 and day 7.Main outcome measuresComposite outcome defined as death before discharge, or moderate to severe bronchopulmonary dysplasia, or severe brain lesions. The association between this outcome and UO was studied using several UO thresholds.ResultsAmong 532 infants studied, UO <1.0 mL/kg/hour for at least 24 consecutive hours was measured in 55/532 (10%) infants and the primary outcome was recorded in 25 patients. The association between a UO threshold <1.0 mL/kg/hour and the primary outcome was found marginally significant (crude OR 1.80, 95% CI 1.02 to 3.16, p=0.04). The primary outcome was recorded in 112/242 (46%) patients with a UO <2.0 mL/kg/hour and only 64/290 (22%) patients with a UO ≥2.0 mL/kg/hour (p<0.001). This UO threshold was found significantly associated with the primary outcome (crude OR 3.1, 95% CI 2.1 to 4.7, p<0.001), an association confirmed using a multivariate logistic regression model including baseline covariates (adjusted OR 3.7, 95% CI 2.2 to 6.4, p<0.001).ConclusionA UO <2 mL/kg/hour over 24 hours between postnatal day 1 and day 7 strongly predicts neonatal mortality or severe morbidities in very preterm infants.

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“…Pediatric nephrology seems to take on this challenge, tailoring parameters to various specific demands, including those of the neonatal period, rare diseases, inherited disorders or peritoneal dialysis [ 7 , 8 , 9 , 10 ].…”

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confidence: 99%