Neonatal nephrotoxic medication exposure and early acute kidney injury: results from the AWAKEN study

Murphy, Heidi J; Charlton, Jennifer R.; Briley, Meagan; Selewski, David T.; Gist, Katja M.; Hanna, Mina; Askenazi, David; Griffin, Russell; Sarkar, Subrata; Kent, Alison; Fletcher, Jeffery; Abitbol, Carolyn; DeFreitas, Marissa; Duara, Shahnaz; Swanson, Jonathan R.; Guillet, Ronnie; D’Angio, Carl T.; Mian, Ayesa; Rademacher, Erin; Mhanna, Maroun J.; Raina, Rupesh; Kumar, Deepak; Ambalavanan, Namasivayam; Arıkan, Ayşe; Rhee, Christopher J.; Goldstein, Stuart L.; Nathan, Amy T.; Kupferman, Juan C.; Bhutada, Alok; Rastogi, Shantanu; Bonachea, Elizabeth; Ingraham, Susan E.; Mahan, John D.; Nada, Arwa; Brophy, Patrick D.; Colaizy, Tarah T.; Klein, Jonathan M.; Cole, F. Sessions; Davis, Thomas K.; Dower, Joshua; Milner, Lawrence S.; Smith, Alexandra; Fuloria, Mamta; Reidy, Kimberly; Kaskel, Frederick J.; Soranno, Danielle E.; Gien, Jason; Chishti, Aftab S.; Hingorani, Sangeeta; Juul, Sandra E.; Starr, Michelle C.; Wong, Craig S.; Joseph, Catherine; DuPont, Tara L.; Ohls, Robin K.; Staples, Amy; Rohatgi, Smriti; Sethi, Sidharth Kumar; Wazir, Sanjay; Khokhar, Surender; Perazzo, Sofia; Ray, Patricio E.; Revenis, Mary; Mammen, Cherry; Synnes, Anne; Wintermark, Pia; Zappitelli, Michael; Woroniecki, Robert; Sridhar, Shanthy

doi:10.1038/s41372-023-01684-7

Cited by 4 publications

(1 citation statement)

References 25 publications

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“…Of neonates, 75% are treated with at least one nephrotoxic medication, i.e., aminoglycosides, during the first postnatal week in the NICU, with a close relationship with AKI [ 95 ]. Behind the high rate of treated patients, this cause of AKI is potentially preventable.…”

Section: Risk Factors For Aki In Neonatal Intensive Carementioning

confidence: 99%

Acute Kidney Injury in Neonatal Intensive Care Unit: Epidemiology, Diagnosis and Risk Factors

Chirico,

Lacquaniti,

Tripodi

et al. 2024

JCM

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Acute kidney injury (AKI) is associated with long-term consequences and poor outcomes in the neonatal intensive care unit. Its precocious diagnosis represents one of the hardest challenges in clinical practice due to the lack of sensitive and specific biomarkers. Currently, neonatal AKI is defined with urinary markers and serum creatinine (sCr), with limitations in early detection and individual treatment. Biomarkers and risk factor scores were studied to predict neonatal AKI, to early identify the stage of injury and not the damage and to anticipate late increases in sCr levels, which occurred when the renal function already began to decline. Sepsis is the leading cause of AKI, and sepsis-related AKI is one of the main causes of high mortality. Moreover, preterm neonates, as well as patients with post-neonatal asphyxia or after cardiac surgery, are at a high risk for AKI. Critical patients are frequently exposed to nephrotoxic medications, representing a potentially preventable cause of AKI. This review highlights the definition of neonatal AKI, its diagnosis and new biomarkers available in clinical practice and in the near future. We analyze the risk factors involving patients with AKI, their outcomes and the risk for the transition from acute damage to chronic kidney disease.

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Section: Risk Factors For Aki In Neonatal Intensive Carementioning

confidence: 99%

Acute Kidney Injury in Neonatal Intensive Care Unit: Epidemiology, Diagnosis and Risk Factors

Chirico,

Lacquaniti,

Tripodi

et al. 2024

JCM

View full text Add to dashboard Cite

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Acute kidney injury in infants with hypoxic-ischemic encephalopathy

Elgendy,

Cortez,

Saker

et al. 2023

Pediatr Nephrol

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Use of urine neutrophil gelatinase-associated lipocalin for nephrotoxic medication acute kidney injury screening in neonates

Slagle,

Hemmelgarn,

Gavigan

et al. 2024

J Perinatol

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BackgroundDaily serum creatinine monitoring protocols for acute kidney injury (AKI) are invasive and may lead to surveillance resistance. We aimed to understand if use of urine neutrophil gelatinase-associated lipocalin (uNGAL) could increase high-risk nephrotoxic medication (NTMx) associated AKI screening adherence in neonates. MethodsStatistical process control methods prior to and post implementation were trended. The primary outcome, screening adherence, was de ned as either daily serum creatinine or uNGAL assessment through 2 days post high-risk NTMx exposure. Results1291 monitoring days from the pre-implementation era (4/2020-6/2021) were compared to1377 monitoring days from the post-era (6/2021-10/2022). AKI screening adherence increased (81-92%) following implementation of optional uNGAL screening. Urine NGAL accounted for 35% of screening obtained with a 40% reduction in blood sampling for serum creatinine. ConclusionsIncorporation of uNGAL as a complementary screening tool to serum creatinine demonstrated sustained increased AKI surveillance in our Baby NINJA monitoring program.

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Neonatal nephrotoxic medication exposure and early acute kidney injury: results from the AWAKEN study

Cited by 4 publications

References 25 publications

Acute Kidney Injury in Neonatal Intensive Care Unit: Epidemiology, Diagnosis and Risk Factors

Acute Kidney Injury in Neonatal Intensive Care Unit: Epidemiology, Diagnosis and Risk Factors

Acute kidney injury in infants with hypoxic-ischemic encephalopathy

Use of urine neutrophil gelatinase-associated lipocalin for nephrotoxic medication acute kidney injury screening in neonates

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