Risk factors for acute kidney injury in neonates with congenital diaphragmatic hernia

Liberio, Brianna; Brinton, John T.; Gist, Katja M.; Soranno, Danielle E.; Kirkley, Megan J.; Gien, Jason

doi:10.1038/s41372-021-01119-1

Cited by 9 publications

(16 citation statements)

References 32 publications

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“…A previously reported study had shown an increased incidence of AKI in CDH infants receiving vancomycin [ 6 ]. While previous studies have shown that gentamicin exposure is associated with AKI in infants with CDH [ 5 , 6 ], our study showed no significant difference. This is may be because all the infants received gentamicin as first line antibiotic in our institution.…”

Section: Discussioncontrasting

confidence: 98%

“…Our study found that ionotrope administration, sepsis, day of surgery or patch repair was not associated with increased incidence of AKI. This was similar to findings from the previous studies [ 5 , 8 ]. Ryan et al found that inotrope administration and sepsis did not affect the incidence of AKI, but patch repair was associated with an increased incidence of AKI [ 6 ].…”

Section: Discussionsupporting

confidence: 93%

“…The increased incidence is likely because of the severe nature of the CDH in our cohort. This is supported by the findings that infants in our cohort with AKI had a median (IQR) O/E LHR at diagnosis of 28.2 (21.2–38.7) compared to the infants in a previous study whose O/E LHR was 38.5 (24.9–48.0) [ 5 ]. In addition to this our results are similar to findings of the CDH subgroup in two previous studies that looked into the incidence of AKI in infants who underwent ECMO [ 8 , 9 ].…”

Section: Discussionsupporting

confidence: 88%

“…In our study, neonatal AKI was diagnosed in approximately 63% of the population, whereas previous studies have reported the incidence varies from 38 to 71% [ 5 , 6 , 8 , 9 ]. The increased incidence is likely because of the severe nature of the CDH in our cohort.…”

Section: Discussionmentioning

confidence: 55%

“…Affected infants are often critically ill with hypoxic respiratory failure requiring high levels of ventilatory support, inotrope administration and nephrotoxic drugs that could lead to acute kidney injury. Previously reported studies have emphasised the significance of AKI in CDH infants and its association with mortality, duration of invasive ventilation and length of neonatal stay [ 5 , 6 ]. Some of those infants required extracorporeal membrane oxygenation (ECMO) which per se can either lead to AKI or aggravate pre-existing AKI [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Acute kidney injury in infants with congenital diaphragmatic hernia

et al. 2022

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Objectives To assess the incidence of acute kidney injury (AKI) in infants with congenital diaphragmatic hernia (CDH), including those who had fetoscopic endoluminal tracheal occlusion (FETO), and the effect of AKI on mortality and length of stay. Study design Ten-year retrospective review of infants admitted with CDH to a tertiary perinatal centre. Result Ninety-four infants with median gestational age of 38+1 weeks were included. Fifty-nine (62.8%) infants had AKI. Compared to infants without AKI, infants with AKI, had a similar incidence of mortality (p = 0.989). In survivors, AKI was not independently associated with a longer adjusted median length of stay [23 versus 15 days (p = 0.194)]. FETO was associated with an increased risk of AKI (p = 0.005), but neither the mortality nor length of stay of FETO infants who had AKI was increased. Conclusion AKI was present in the majority of infants with CDH and most common in those who had undergone FETO.

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Section: Discussioncontrasting

confidence: 98%

Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 55%

Section: Introductionmentioning

confidence: 99%

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Acute kidney injury in infants with congenital diaphragmatic hernia

et al. 2022

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Arterial hypertension in infants with congenital diaphragmatic hernia following surgical repair

Engel,

Leyens,

et al. 2024

Eur J Pediatr

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Pulmonary hypertension (PH) and cardiac dysfunction are established comorbidities of congenital diaphragmatic hernia (CDH). However, there is very little data focusing on arterial hypertension in CDH. This study aims to investigate the incidence of arterial hypertension in neonates with CDH at hospital discharge. Archived clinical data of 167 CDH infants who received surgical repair of the diaphragmatic defect and survived for > 60 days were retrospectively analyzed. Blood pressure (BP) values were averaged for the last 7 days before discharge and compared to standard BP values for sex, age, and height provided by the AHA in 2004. BP values reaching or extending the 95th percentile were defined as arterial hypertension. The use of antihypertensive medication was analyzed at discharge and during hospitalization. Arterial hypertension at discharge was observed in 19 of 167 infants (11.3%) of which 12 (63%) were not receiving antihypertensive medication. Eighty patients (47.9%) received antihypertensive medication at any point during hospitalization and 28.9% of 152 survivors (n = 44) received antihypertensive medication at discharge, although in 45.5% (n = 20) of patients receiving antihypertensive medication, the indication for antihypertensive medication was myocardial hypertrophy or frequency control. BP was significantly higher in ECMO compared to non-ECMO patients, despite a similar incidence of arterial hypertension in both groups (13.8% vs. 10.1%, p = 0.473). Non-isolated CDH, formula feeding, and minimal creatinine in the first week of life were significantly associated with arterial hypertension on univariate analysis. Following multivariate analysis, only minimal creatinine remained independently associated with arterial hypertension. Conclusion: This study demonstrates a moderately high incidence of arterial hypertension in CDH infants at discharge and an independent association of creatinine values with arterial hypertension. Physicians should be aware of this risk and include regular BP measurements and test of renal function in CDH care and follow-up. What is Known:• Due to decreasing mortality, morbidity is increasing in surviving CDH patients.• Pulmonary hypertension and cardiac dysfunction are well-known cardiovascular comorbidities of CDH. What is New:• There is a moderately high incidence of arterial hypertension in CDH infants at discharge even in a population with frequent treatment with antihypertensive medication.• A more complicated hospital course (ECMO, higher degree of PH, larger defect size) was associated with a higher risk for arterial hypertension.

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Acute kidney injury, fluid balance, and continuous renal replacement therapy in children and neonates treated with extracorporeal membrane oxygenation

Gist,

Bastero,

Ricci

et al. 2024

Intensive Care Med. Paediatr. Neonatal

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Extracorporeal membrane oxygenation (ECMO) is a lifesaving therapy used primarily for reversible cardiopulmonary failure across the lifespan. Mortality from multiple organ failure on ECMO is high, and unfortunately, complications such as acute kidney injury (AKI) and disorders of fluid balance such as fluid overload (FO) necessitating continuous renal replacement therapy (CRRT) are also common. The largest series of AKI, FO and ECMO related outcomes has been published by the Kidney Interventions During Membrane Oxygenation (KIDMO) multicenter study, which demonstrated patients with AKI and FO have worse outcomes, corroborating with findings from previous single center studies. There are multiple ways to perform CRRT during ECMO, but integration of a CRRT machine in series is the most common approach in neonates and children. The optimal timing of when to initiate CRRT, and how fast to remove fluid during ECMO remain unknown, and there is an urgent need to design studies with these research questions in mind. The disposition and clearance of drugs on ECMO also require urgent study, as drugs metabolism not only is disproportionately affected by the presence of AKI and FO, but also by CRRT prescription and the rate of fluid removal. In this review, we discuss the contemporary epidemiology and outcomes of AKI and FO during ECMO, as well as the use of concurrent CRRT and highlight evidence gaps as a research map.

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Risk factors for acute kidney injury in neonates with congenital diaphragmatic hernia

Cited by 9 publications

References 32 publications

Acute kidney injury in infants with congenital diaphragmatic hernia

Acute kidney injury in infants with congenital diaphragmatic hernia

Arterial hypertension in infants with congenital diaphragmatic hernia following surgical repair

Acute kidney injury, fluid balance, and continuous renal replacement therapy in children and neonates treated with extracorporeal membrane oxygenation

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