Prediction of risk factors and outcomes of neonatal acute kidney injury

Abstract

Introduction Neonatal Acute kidney injury (AKI) is an underestimated morbidity in the neonatal intensive care unit (ICU). However, there is a paucity of information about risk factors, outcomes, and possible preventive measures to limit its occurrence. Aim This study aimed to determine the prevalence of neonatal AKI in a neonatal ICU. Data obtained from this study will help to better understand current local practices and investigate possible preventive strategies. Materials and methods Charts from January 2011 to December 2018 were reviewed. Neonates less than 2 weeks old who depended on intravenous fluid as a nutrition source for at least two days were included. Results Overall, the eight-year prevalence of neonatal AKI in the neonatal ICU was 19.6%, and severity was distributed as follows: stage 1 (46.2%), stage 2 (26.5%), and stage 3 (27.3%). Caffeine administration before 29 weeks’ gestational age significantly decreased the incidence of neonatal AKI. The incidence of neonatal AKI was independently associated with death (odds ratios (OR) = 7.11, P < 0.001) and extended length of hospital stay (OR = 2.47, P < 0.001). In the multivariate regression model, vancomycin (AOR = 1.637, P < 0.004), loop diuretics (AOR = 2.203, P < 0.001), intraventricular hemorrhage (AOR = 2.605, P < 0.001), surgical intervention (AOR = 1.566, P < 0.008), mechanical ventilation (AOR = 1.463, P < 0.015), and dopamine administration (AOR = 2.399, P < 0.001) were independently associated with neonatal AKI. Conclusion Neonatal AKI occurred in one-fifth of the study population in a neonatal ICU. Outcomes can be improved by identifying high-risk infants and cautiously monitoring kidney function.

Neonatal AKI profile using KDIGO guidelines: A cohort study in tertiary care hospital ICU of Lahore, Pakistan

“…Elmas et al [25] have observed a significant incidence of AKI in neonates having a central venous catheter (p 0.001) and umbilical catheter (p 0.002). AlGadeeb has documented that the presence of central lines, as well as umbilical arterial catheter, are significantly associated with AKI [27]. In our cohort, all neonates with central lines had a significantly higher incidence of AKI.…”

“…Jetton et al analysis shows that neonates with AKI have 8.8 times longer duration of stay and 4.6 times higher mortality as compared to the non-AKI group [5]. Comparing different stages of AKI, the higher the order of renal failure poor is the outcome [11,20,21,26,27]. Irrespective of severity, all neonates in our cohort with AKI had significantly longer length of stay and higher odds of death.…”

“…Hence, it leads to decreased renal blood flow resulting in renal vasoconstriction, decreased GFR, and ultimately causes renal failure [2]. Mechanical ventilation, hsPDA, and sepsis are considered as significant risk factors for neonatal AKI [1,19,[23][24][25][26][27][28]. Our study shows that these factors add risk to renal insult but are statistically insignificant.…”

“…Neonates requiring inotropic support have a higher incidence of AKI as has been reported in multiple studies. [6,10,11,25,27]. All of our neonates who required inotropic agents had double the odds of AKI.…”

“…AlGadeeb and Marciniak have reported intraventricular hemorrhage as a significant risk factor for neonatal acute kidney injury (p <0.001, AOR 2.605, 95%CI 1.465 - 4.631) and (OR 2.38, 95%CI 1.46 - 3.87) respectively [27,33]. DIC has been reported as a significant risk factor for neonatal acute kidney injury by Nickavar.…”