Nephrotoxic medication exposure in very low birth weight infants

Rhone, Erika T.; Carmody, John; Swanson, Jonathan R.; Charlton, Jennifer R.

doi:10.3109/14767058.2013.860522

Cited by 136 publications

(78 citation statements)

References 26 publications

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“…60,61 Exposure to nephrotoxic medications is also associated with AKI in neonates and may represent a modifiable risk factor. 47,48,62 Table 3 provides a description of common nephrotoxic medications used in the NICU. In 2013, Rhone et al 62 evaluated the epidemiology and impact of nephrotoxic medication exposure in 107 very low birth weight (VLBW) infants.…”

Section: Nephrotoxic Medicationsmentioning

confidence: 99%

“…47,48,62 Table 3 provides a description of common nephrotoxic medications used in the NICU. In 2013, Rhone et al 62 evaluated the epidemiology and impact of nephrotoxic medication exposure in 107 very low birth weight (VLBW) infants. In this study, 87% of neonates were exposed to at least 1 nephrotoxic medication and on average these neonates were exposed to 14 days of nephrotoxic medications during their NICU stay.…”

Section: Nephrotoxic Medicationsmentioning

confidence: 99%

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Neonatal Acute Kidney Injury

et al. 2015

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In recent years, there have been significant advancements in our understanding of acute kidney injury (AKI) and its impact on outcomes across medicine. Research based on single-center cohorts suggests that neonatal AKI is very common and associated with poor outcomes. In this state-of-the-art review on neonatal AKI, we highlight the unique aspects of neonatal renal physiology, definition, risk factors, epidemiology, outcomes, evaluation, and management of AKI in neonates. The changes in renal function with gestational and chronologic age are described. We put forth and describe the neonatal modified Kidney Diseases: Improving Global Outcomes AKI criteria and provide the rationale for its use as the standardized definition of neonatal AKI. We discuss risk factors for neonatal AKI and suggest which patient populations may warrant closer surveillance, including neonates ,1500 g, infants who experience perinatal asphyxia, near term/ term infants with low Apgar scores, those treated with extracorporeal membrane oxygenation, and those requiring cardiac surgery. We provide recommendations for the evaluation and treatment of these patients, including medications and renal replacement therapies. We discuss the need for long-term follow-up of neonates with AKI to identify those children who will go on to develop chronic kidney disease. This review highlights the deficits in our understanding of neonatal AKI that require further investigation. In an effort to begin to address these needs, the Neonatal Kidney Collaborative was formed in 2014 with the goal of better understanding neonatal AKI, beginning to answer critical questions, and improving outcomes in these vulnerable populations.

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Section: Nephrotoxic Medicationsmentioning

confidence: 99%

Section: Nephrotoxic Medicationsmentioning

confidence: 99%

Neonatal Acute Kidney Injury

et al. 2015

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“…Cystatin C levels may reflect renal function better than creatinine, and various biomarkers are being investigated as a tool to detect AKI early [139,140]. The major risk factors for neonatal AKI are preterm birth, LBW, reduced nephron numbers, critical illness, and nephrotoxin exposure [58,136,141,142,143]. All of these factors in turn may also reduce the potential for postnatal nephrogenesis, which can occur for a limited period following preterm birth [58].…”

Section: Introduction To a Health Problemmentioning

confidence: 99%

The Impact of Kidney Development on the Life Course: A Consensus Document for Action

Brenner

Charlton

Luyckx

et al. 2017

Nephron

119

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Hypertension and chronic kidney disease (CKD) have a significant impact on global morbidity and mortality. The Low Birth Weight and Nephron Number Working Group has prepared a consensus document aimed to address the relatively neglected issue for the developmental programming of hypertension and CKD. It emerged from a workshop held on April 2, 2016, including eminent internationally recognized experts in the field of obstetrics, neonatology, and nephrology. Through multidisciplinary engagement, the goal of the workshop was to highlight the association between fetal and childhood development and an increased risk of adult diseases, focusing on hypertension and CKD, and to suggest possible practical solutions for the future. The recommendations for action of the consensus workshop are the results of combined clinical experience, shared research expertise, and a review of the literature. They highlight the need to act early to prevent CKD and other related noncommunicable diseases later in life by reducing low birth weight, small for gestational age, prematurity, and low nephron numbers at birth through coordinated interventions. Meeting the current unmet needs would help to define the most cost-effective strategies and to optimize interventions to limit or interrupt the developmental programming cycle of CKD later in life, especially in the poorest part of the world.

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“…Extended stays in the NICU with central lines and IVs put infants with already vulnerable immune systems at risk for sepsis [22]. Kidney and liver injury can result from nonsteroidal anti-inflammatory drugs (NSAIDs), antibiotics, and total parenteral nutrition (TPN) [23,24]. Cholestasis, osteopenia of prematurity, and vascular thrombosis from the central line can result from a prolonged requirement for TPN [24,25].…”

Section: Risks Associated With Extremely Preterm Births and Resuscitamentioning

confidence: 99%

Should Long-Term Consequences of NICU Care Be Discussed in Terms of Prognostic Uncertainty or Possible Harm?

Allen¹,

Laventhal²

2017

AMA Journal of Ethics

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We will examine several ethical considerations in the resuscitation of infants born at the margin of gestational viability in analyzing a case of preterm labor. More specifically, we will discuss the obligations of physicians in characterizing expected outcomes, both mortality and longterm morbidity, for extremely premature infants and how potential adverse outcomes should be framed-as complications of prematurity itself or as iatrogenic complications of care. We will also explore how the concept of a "trial of therapy" can support parents and neonatologists in decision making concerning withholding or withdrawing care for periviable infants. CaseDr. Mattingly met Miriam and Thomas when Miriam arrived a week ago in preterm labor, which was successfully stopped with tocolytics. Suspecting that Miriam would again have preterm labor, that the baby would be born extremely prematurely, needing NICU care to survive, and that the baby's prognosis might be poor, he has met with the couple over the last few days to determine which NICU interventions they might want.Miriam and Thomas wanted to know what sort of life their baby would have if they committed to doing everything NICU staff could to help him live. Dr. Mattingly explained that there had been significant advancements in the care of premature infants, but that the future of their child was still uncertain. He discussed various risks premature infants might face including breathing difficulty related to immature lungs, which might necessitate a breathing tube and could result in long-term problems, and injury to the developing brain and eyes that could result in lifelong sensory, cognitive, and motor impairments. He discussed surgery their child might need for his heart, and the risk of intestinal injury and infections while in the NICU. He told the couple that their child might die early or late in his NICU course. "Of course," Dr. Mattingly had said, "decisions about when and how much to intervene are up to you." He also explained the option of comfort care, which would focus on keeping the infant comfortable after birth, without attempts at resuscitation; in this case, the focus would not be on survival, but on making sure the time he had would be as peaceful as possible.

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Nephrotoxic medication exposure in very low birth weight infants

Abstract: VLBW infants are frequently exposed to nephrotoxic medications, receiving approximately two weeks of nephrotoxic medications before discharge or 1 for every 6 d of hospitalization. The greatest exposure occurred among the smallest, most immature infants and those who experienced AKI.

Cited by 136 publications

References 26 publications

Neonatal Acute Kidney Injury

Neonatal Acute Kidney Injury

The Impact of Kidney Development on the Life Course: A Consensus Document for Action

Should Long-Term Consequences of NICU Care Be Discussed in Terms of Prognostic Uncertainty or Possible Harm?

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