Severe acute kidney injury in neonates with necrotizing enterocolitis: risk factors and outcomes

Garg, Parvesh Mohan; Britt, Anna B.; Ansari, Abu Yusuf; Sobisek, Sarah; Block, Danielle K.; Paschal, Jaslyn L.; Ojeda, Norma B.; Askenazi, David; Sanderson, Keia

doi:10.1038/s41390-020-01320-6

Cited by 34 publications

(26 citation statements)

References 34 publications

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“…According to Garg et al, all neonates whose mothers have received antenatal steroids are at higher risk (AOR 3.9, 95%CI 1.1 - 8.9) of developing AKI [20,30]. All neonates in our study has 72% higher risk of AKI.…”

Section: Discussionmentioning

confidence: 56%

“…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.…”

Section: Discussionmentioning

confidence: 78%

“…Literature review reveals that out-born birth was a unique risk factor for AKI in neonates. All sick neonates who require transfer due to any medical or surgical reason are at high risk of developing AKI [5,9,20]. Gohiya has reported a significantly higher incidence (p=0.02) of AKI in outborn neonates [21].…”

Section: Discussionmentioning

confidence: 99%

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

Gul¹,

Anwar²,

Sheikh

et al. 2022

Preprint

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Background AKI is witnessed in sick neonates and is associated with poor outcomes. Our cohort represents the profile of neonates who were diagnosed with AKI using KDIGO guidelines during intensive care unit stay. Methodology A cohort study was conducted in the NICU of FMH from June 2019 to May 2021. Data were collected on standardized proforma. Serum creatinine was measured within 24 hours after enrollment in the study by cytometric analysis using the C311 Rosch machine and subsequently after 24 to 48 hours. Data analysis was done using SPSS v 20.0. All continuous variables were not normally distributed and were expressed as the median and interquartile range (IQR). Categorical variables were analyzed by proportional differences with either the Pearson chi-square test or Fisher’s exact tests. A multinomial logistic regression model was used to explore the independent risk factors of AKI. Time to the event (death) and survival curves for the cohort were plotted by using Cox proportional hazard model. Results AKI occurred in 473 (37.6%) of neonates and 15.7%, 16.3% and 5.6% had stage 1, 2 and 3 respectively. The outborn birth (p 0.000, AOR 3.987, 95%CI 2.564 – 6.200), birth asphyxia (p 0.000, AOR 3.567, 95%CI 2.093 – 6.080), inotropic agent (p 0.000, AOR 2.060, 95%CI 1.436 – 2.957), antenatal steroids (p 0.002, AOR 1.721, 95%CI 1.213 – 2.443), central lines (p 0.005, AOR 1.630, 95%CI 1.155 – 2.298), IVH/ICH/DIC (p 0.009, AOR1.580 , 95%CI 1.119 – 2.231) and NEC (p 0.054, AOR 1.747, 95%CI 0.990 – 3.083) were independently associated with AKI. Protective factors of neonatal AKI were normal sodium levels, maternal diabetes mellitus as well Hb>10.5 mg/dl. Duration of stay (7 vs 9 days) and mortality rates (3.9% vs16.5%) were significantly higher in neonates with AKI (p <0.001). Conclusion About one-third of critically sick neonates had AKI. Significant risk factors for AKI were outborn birth (298%), birth asphyxia (256%), inotropic agents (106%) %, NEC 74.7%, antenatal steroids 72%, central lines 63% and IVH/ICH/DIC 58%. AKI prolongs the duration of stay and reduces the survival of sick neonates.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 78%

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

Gul¹,

Anwar²,

Sheikh

et al. 2022

Preprint

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“…Necrotizing enterocolitis (NEC) occurs in 2–5% of NICU admissions and represents a significant cause of morbidity and mortality. Infants with NEC have multiple risk factors for AKI including sepsis, hemodynamic instability, NTX receipt, systemic inflammation, increased intrabdominal pressure, and frequently prematurity ( 36 , 37 ). In a single center retrospective study of 202 neonates with NEC, the overall incidence of severe AKI was 32.6% and in those requiring surgical intervention, the incidence was 58.7% ( 36 ).…”

Section: Epidemiology Risk Factors and Outcomes Of Neonatal Akimentioning

confidence: 99%

“…Infants with NEC have multiple risk factors for AKI including sepsis, hemodynamic instability, NTX receipt, systemic inflammation, increased intrabdominal pressure, and frequently prematurity ( 36 , 37 ). In a single center retrospective study of 202 neonates with NEC, the overall incidence of severe AKI was 32.6% and in those requiring surgical intervention, the incidence was 58.7% ( 36 ). This study also showed that severe AKI was associated with a longer length of stay {124 days [interquartile range (IQR) 88–187] vs. 82 days (42–126); p < 0.001}.…”

Section: Epidemiology Risk Factors and Outcomes Of Neonatal Akimentioning

confidence: 99%

Neonatal Acute Kidney Injury

et al. 2022

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Acute kidney injury (AKI) is a common occurrence in the neonatal intensive care unit (NICU). In recent years, our knowledge of the incidence and impact of neonatal AKI on outcomes has expanded exponentially. Neonatal AKI has been shown to be associated with adverse outcomes including increased length of mechanical ventilation, prolonged length of stay, and rise in mortality. There has also been increasing work suggesting that neonates with AKI are at higher risk of chronic kidney disease (CKD). In the past, AKI had been defined multiple ways. The utilization of the neonatal modified Kidney Disease: Improving Global Outcomes (KDIGO) criteria as the standard definition for neonatal AKI in research and clinical care has driven the advances in our understanding of neonatal AKI over the last 10 years. This definition has allowed researchers and clinicians to better understand the incidence, risk factors, and outcomes associated with neonatal AKI across populations through a multitude of single-center studies and the seminal, multicenter Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) study. As the impacts of neonatal AKI have become clear, a shift in efforts toward identifying those at highest risk, protocolizing AKI surveillance, improving prevention and diagnosis, and expanding kidney support therapy (KST) for neonates has occurred. These efforts also include improving risk stratification (identifying high risk populations, including those with nephrotoxic medication exposure) and diagnostics (novel biomarkers and diagnostic tools). Recent work has also shown that the targeted use of methylxanthines may prevent AKI in a variety of high-risk populations. One of the most exciting developments in neonatal AKI is the advancement in technology to provide KST to neonates with severe AKI. In this comprehensive review we will provide an overview of recent work and advances in the field of neonatal AKI. This will include a detailed review of (1) the definition of neonatal AKI, (2) the epidemiology, risk factors, and outcomes associated with neonatal AKI, (3) improvements in risk stratification and diagnostics, (4) mitigation and treatment, (5) advancements in the provision of KST to neonates, and (6) the incidence and risk of subsequent CKD.

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Incidence, Risk Factors, and Outcomes Associated With Recurrent Neonatal Acute Kidney Injury in the AWAKEN Study

Rutledge,

Griffin,

Vincent

et al. 2024

JAMA Netw Open

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ImportanceThe incidence and associated outcomes of recurrent acute kidney injury (rAKI) in neonates remain largely unknown.ObjectiveTo determine the incidence, risk factors, and clinical outcomes associated with rAKI in critically ill neonates.Design, Setting, and ParticipantsThis cohort study was a secondary analysis of the multicenter, international Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates retrospective study. Comparisons were made among neonates with no AKI, a single AKI episode (sAKI), and rAKI. All neonates younger than 14 days who were admitted between January 1 and March 31, 2014, to 24 participating level II to IV neonatal intensive care units and received intravenous fluids for at least 48 hours were considered for inclusion. Neonates with congenital heart disease requiring surgery within the first week of life, lethal chromosomal anomalies, death within 48 hours of admission, or severe congenital kidney abnormalities were excluded. Data were analyzed from May 23, 2022, to December 8, 2023.ExposureRecurrent AKI using the neonatal Kidney Disease: Improving Global Outcomes criteria. Determination of each rAKI required a complete return to the baseline serum creatinine level that defined the prior AKI episode.Main Outcomes and MeasuresIncidence and risk factors of rAKI and associations of rAKI with length of stay (LOS; ie, birth to hospital discharge) and mortality.ResultsThe study cohort (n = 2162) included 1233 male neonates (57.0%). Gestational age distribution was less than 29 weeks for 276 neonates (12.8%), 29 to less than 36 weeks for 958 (44.3%), and 36 weeks or older for 928 (42.9%). Of 605 neonates with AKI, 133 (22.0%) developed rAKI with risk factors including younger gestational age, lower birthweight, and higher stage of initial AKI. Infants with rAKI experienced longer median LOS (no AKI, 17 [IQR, 8-34] days; sAKI, 18 [IQR, 9-45] days; rAKI, 60 [IQR, 25-109] days; P &lt; .001). Time-varying Cox proportional hazards regression models suggest rAKI is independently associated with a lower hazard of discharge (adjusted hazard ratio, 0.7 [95% CI, 0.6-0.9]; P = .01) when compared with sAKI, but mortality did not differ between groups (adjusted hazard ratio, 1.4 [95% CI, 0.6-3.0]; P = .44).Conclusions and RelevanceIn this cohort study, neonatal rAKI was independently associated with longer LOS when compared with sAKI, suggesting that rAKI in neonates may be an important clinical distinction warranting further study and careful monitoring after an initial AKI episode.

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Severe acute kidney injury in neonates with necrotizing enterocolitis: risk factors and outcomes

Cited by 34 publications

References 34 publications

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

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

Neonatal Acute Kidney Injury

Incidence, Risk Factors, and Outcomes Associated With Recurrent Neonatal Acute Kidney Injury in the AWAKEN Study

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