Neonatal acute kidney injury: recording rate, course, and outcome: one center experience

Cleper, Roxana; Shavit, Itay; Blumenthal, Danit; Reisman, Lewis; Pomeranz, Galit; Haham, Alon; Friedman, S; Goldiner, Ilana; Mandel, Dror

doi:10.1080/14767058.2018.1463985

Cited by 13 publications

(11 citation statements)

References 35 publications

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“…To date, a uniform definition of AKI is still lacking, and, in the first week after birth, it needs to consider the developing renal physiology [26,27]. We acknowledge that using a different definition of AKI could change its incidence in our population.…”

Section: Discussionmentioning

confidence: 99%

Early Acute Kidney Injury in Preterm and Term Neonates: Incidence, Outcome, and Associated Clinical Features

et al. 2021

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Background: Critically ill neonates are at high risk of kidney injury, mainly in the first days of life. Acute kidney injury (AKI) may be underdiagnosed due to lack of a uniform definition. In addition, long-term renal follow-up is limited. Objective: To describe incidence, etiology, and outcome of neonates developing AKI within the first week after birth in a cohort of NICU-admitted neonates between 2008 and 2018. Renal function at discharge in infants with early AKI was assessed. Methods and Subjects: AKI was defined as an absolute serum Cr (sCr) value above 1.5 mg/dL (132 μmol/L) after the first 24 h or as stage 2–3 of the NIDDK neonatal definition. Clinical data and outcomes were collected from medical records and retrospectively analyzed. Results: From January 2008 to December 2018, a total of 9,376 infants were admitted to the NICU of Wilhelmina Children’s Hospital/UMC Utrecht, of whom 139 were diagnosed with AKI during the first week after birth. In 72 term infants, the most common etiology was perinatal asphyxia (72.2%), followed by congenital kidney and urinary tract malformations (CAKUT) (8.3%), congenital heart disease (6.9%), and sepsis (2.8%). Associated conditions in 67 preterm infants were medical treatment of a hemodynamic significant PDA (27.2%), CAKUT (21%), and birth asphyxia (19.4%). Among preterm neonates and neonates with perinatal asphyxia, AKI was mainly diagnosed by the sCr >1.5 mg/dL criterion. Renal function at discharge improved in 76 neonates with AKI associated with acquired conditions. Neonates with stage 3 AKI showed increased sCr values at discharge. Half of these were caused by congenital kidney malformations and evolved into chronic kidney disease (CKD) later in life. Neurodevelopmental outcome (NDO) at 2 years was favorable in 93% of surviving neonates with detailed follow-up. Conclusion: During the first week after birth, AKI was seen in 1.5% of infants admitted to a level III NICU. Renal function at discharge had improved in most neonates with acquired AKI but not in infants diagnosed with stage 3 AKI. Long-term renal function needs further exploration, whereas NDO appears to be good.

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Section: Discussionmentioning

confidence: 99%

Early Acute Kidney Injury in Preterm and Term Neonates: Incidence, Outcome, and Associated Clinical Features

et al. 2021

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“…In an Israeli single center study performed on a neonatal ICU the authors demonstrated underreporting of AKI, with episodes of kidney injury often not recorded in pati ents' medical files 19) . This is of particular concern, because over the past decade the longterm consequences of AKI have garnered increased attention and several cohort studies demonstrate that pediatric AKI is a gateway for proteinuria, hypertension, and CKD in later life.…”

Section: Aki In Childrenmentioning

confidence: 99%

Contrast-Associated Acute Kidney Injury (CA-AKI) in Children: Special Considerations

Windpessl¹,

Kronbichler²

2019

Child Kidney Dis

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Contrast-associated acute kidney injury (CA-AKI) is a major concern when iodinated contrast material is administered, especially in patients at risk. Efforts have been undertaken to understand the detrimental effects of contrast media (CM). With the use of low-osmolar or iso-osmolar CM the incidence of CA-AKI has steadily decreased within the past decade; however, especially in the pediatric population information is scarce. Incidence rates have been reported to range between 0% to 18.75%, particularly depending on indication, selection of population (i.e. preexisting co-morbidities), and definition of AKI. Different biomarkers have been proposed, but confirmatory studies are either lacking or have contributed to their lack of diagnostic power. Proteomic approaches have been employed and may pave the way to such discovery. Prevention strategies have been tested and proposed, but the recently published AMACING and PRESERVE trials have shown that commonly used strategies (such as systematic hydration or administration of N-acetylcysteine) have no role in the prevention of CA-AKI. We propose that thoughtful assessment of one's fluid state is the most appropriate approach and depending on the hydration status diuretics or fluid administration should be provided to achieve an euvolemic state ahead of contrast exposure.

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“…To date, as the diagnostic criteria for neonatal AKI are not uniform and the incidence of AKI in neonates included in studies varies widely, the incidence of neonatal AKI has been inconsistently reported in the literature, ranging from 18-40% [28].Due to the unique pathophysiological characteristics of neonates with AKI, they differ signi cantly from adults and the currently improving and maturing clinical criteria for the diagnosis of AKI in adults are not applicable to the diagnosis of AKI in neonates [29].The use of traditional criteria for predicting the occurrence of AKI does not truly re ect the occurrence of AKI in newborns.On the one hand, AKI caused by non-pharmacological factors such as prematurity combined with hypoxemia, sepsis, necrotizing small bowel colitis and arteriovenous catheterization may be included [30]. On the other hand, the poor consistency of all criteria for diagnosing AKI may lead to clinical underdiagnosis of some AKI in neonates [31].We did not evaluate the occurrence of AKI in neonates in this study. It is expected that the combined detection of multiple biomarkers to predict AKI of vancomycin in newborns will provide a realistic evaluation of its nephrotoxicity in our further study.…”

Section: Discussionmentioning

confidence: 98%

Vancomycin Dosing Regimens based on Monte Carlo Simulation for Treated Gram-positive cocci Infection in neonates: A retrospective observational study

Zhao

Liu

Chang

et al. 2022

Preprint

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Background: The pharmacodynamic and pharmacokinetic profiles of vancomycin in neonatal population have been previously reported. However, a consensus still has not been reached about optimal recommended dose. Few studies on neonatal population are available relating particularly to distribution of pathogens and clinical outcome.Therefore, we sought to optimise the drug-dosing regimen based on Monte Carlo Simulation and conducted a retrospective observational study to assess the trough concentration and clinical efficacy. Methods: We collected data from neonates who were treated with vancomycin from November 2018 to December 2021. Based on the inclusion criteria, pharmacokinetic model group and observation group were selected for further inclusion. The recommended pharmacokinetic-pharmacodynamic(PK-PD) target AUC/MIC ratio for vancomycin is ≥400. The achieved goal of the probability of target attainment (PTA) and a cumulative fraction of response (CFR) were ≥90%. Monte-Carlo simulations were performed to identify optimal dosing regimens. Statistical analysis were performed to compare trough concentrations and effectiveness of the different treatment options. Results: We collected pharmacokinetic data on a total of 137 neonates ( 92 male and 45 female) and 124 neonates ( 180 dosing regimens and 180 plasma trough concentration) were retrospectively analyzed in this study. The recommended doses required to achieve the goal of PTA or CFR from 25 to 225mg/d depending on PK-PD target in different subgroups. Recommended dosage regimen group ( n=80 ) presented higher values (P＜0.05）in trough concentration than in not-recommended groups ( n=100 ), yet the target concentration ( 5-15mg/l ) compliance rate indicates no significant differences (P＞0.05). Recommended dosage neonate group ( n=53 ) presented higher clinical response rate (P＜0.05）than in not-recommended groups ( n=71 ). Conclusion: Large differences of required daily dose exist among different newborn subgroups. A higher trough level and clinical efficacy was reached in simulated recommended doses regimen. However target concentration compliance rate indicates no significant change. A more scientific and standard study of multi-center were needed to optimize recommended dose and evaluate the real-world efficacy and safety of vancomycin.

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Neonatal acute kidney injury: recording rate, course, and outcome: one center experience

Cited by 13 publications

References 35 publications

Early Acute Kidney Injury in Preterm and Term Neonates: Incidence, Outcome, and Associated Clinical Features

Early Acute Kidney Injury in Preterm and Term Neonates: Incidence, Outcome, and Associated Clinical Features

Contrast-Associated Acute Kidney Injury (CA-AKI) in Children: Special Considerations

Vancomycin Dosing Regimens based on Monte Carlo Simulation for Treated Gram-positive cocci Infection in neonates: A retrospective observational study

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