Incidence and Risk Factors of Early Onset Neonatal AKI
Jennifer R Charlton, Louis Boohaker, David Askenazi, Patrick D Brophy, Carl D'Angio, Mamta Fuloria, Jason Gien, Russell Griffin, Sangeeta Hingorani, Susan Ingraham, Ayesa Mian, Robin K Ohls, Shantanu Rastogi, Christopher J Rhee, Mary Revenis, Subrata Sarkar, Alexandra Smith, Michelle Starr, Alison L Kent, Neonatal Kidney Collaborative, Namasivayam Ambalavanan, David T Selewski, Jeffery Fletcher, Carolyn L Abitbol, Ronnie Guillet, Marissa DeFreitas, Shahnaz Duara, Erin Rademacher, Maroun J Mhanna, Rupesh Raina, Deepak Kumar, Ayse Akcan Arikan, Stuart L Goldstein, Amy T Nathan, Juan C Kupferman, Alok Bhutada, Elizabeth Bonachea, John Mahan, Arwa Nada, Jennifer Jetton, Tarah T Colaizy, Jonathan M Klein, F Sessions Cole, T Keefe Davis, Joshua Dower, Lawrence Milner, Kimberly Reidy, Frederick J Kaskel, Katja M Gist, Mina H Hanna, Craig S Wong, Catherine Joseph, Tara DuPont, Amy Staples, Surender Khokhar, Sofia Perazzo, Patricio E Ray, Cherry Mammen, Anne Synnes, Pia Wintermark, Michael Zappitelli, Sidharth K Sethi, Sanjay Wazir, Smriti Rohatgi, Danielle E Soranno, Aftab S Chishti, Robert Woroniecki, Jonathan R Swanson, Shanty Sridhar, Jennifer R Charlton, Louis Boohaker, David Askenazi, Patrick D Brophy, Carl D'Angio, Mamta Fuloria, Jason Gien, Russell Griffin, Sangeeta Hingorani, Susan Ingraham, Ayesa Mian, Robin K Ohls, Shantanu Rastogi, Christopher J Rhee, Mary Revenis, Subrata Sarkar, Alexandra Smith, Michelle Starr, Alison L Kent, Neonatal Kidney Collaborative, Namasivayam Ambalavanan, David T Selewski, Jeffery Fletcher, Carolyn L Abitbol, Ronnie Guillet, Marissa DeFreitas, Shahnaz Duara, Erin Rademacher, Maroun J Mhanna, Rupesh Raina, Deepak Kumar, Ayse Akcan Arikan, Stuart L Goldstein, Amy T Nathan, Juan C Kupferman, Alok Bhutada, Elizabeth Bonachea, John Mahan, Arwa Nada, Jennifer Jetton, Tarah T Colaizy, Jonathan M Klein, F Sessions Cole, T Keefe Davis, Joshua Dower, Lawrence Milner, Kimberly Reidy, Frederick J Kaskel, Katja M Gist, Mina H Hanna, Craig S Wong, Catherine Joseph, Tara DuPont, Amy Staples, Surender Khokhar, Sofia Perazzo, Patricio E Ray, Cherry Mammen, Anne Synnes, Pia Wintermark, Michael Zappitelli, Sidharth K Sethi, Sanjay Wazir, Smriti Rohatgi, Danielle E Soranno, Aftab S Chishti, Robert Woroniecki, Jonathan R Swanson, Shanty Sridhar
Abstract
Background and objectives: Neonatal AKI is associated with poor short- and long-term outcomes. The objective of this study was to describe the risk factors and outcomes of neonatal AKI in the first postnatal week.
Design, setting, participants, & measurements: The international retrospective observational cohort study, Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN), included neonates admitted to a neonatal intensive care unit who received at least 48 hours of intravenous fluids. Early AKI was defined by an increase in serum creatinine >0.3 mg/dl or urine output <1 ml/kg per hour on postnatal days 2-7, the neonatal modification of Kidney Disease: Improving Global Outcomes criteria. We assessed risk factors for AKI and associations of AKI with death and duration of hospitalization.
Results: Twenty-one percent (449 of 2110) experienced early AKI. Early AKI was associated with higher risk of death (adjusted odds ratio, 2.8; 95% confidence interval, 1.7 to 4.7) and longer duration of hospitalization (parameter estimate: 7.3 days 95% confidence interval, 4.7 to 10.0), adjusting for neonatal and maternal factors along with medication exposures. Factors associated with a higher risk of AKI included: outborn delivery; resuscitation with epinephrine; admission diagnosis of hyperbilirubinemia, inborn errors of metabolism, or surgical need; frequent kidney function surveillance; and admission to a children's hospital. Those factors that were associated with a lower risk included multiple gestations, cesarean section, and exposures to antimicrobials, methylxanthines, diuretics, and vasopressors. Risk factors varied by gestational age strata.
Conclusions: AKI in the first postnatal week is common and associated with death and longer duration of hospitalization. The AWAKEN study demonstrates a number of specific risk factors that should serve as "red flags" for clinicians at the initiation of the neonatal intensive care unit course.
Trial registration: ClinicalTrials.gov NCT02443389.
Keywords: Acute Kidney Injury; Anti-Infective Agents; Cesarean Section; Children; Epinephrine; Gestational Age; Hyperbilirubinemia; Incidence; Infant; Intensive Care Units; Mating Factor; Neonatal; Newborn; Pregnancy; Retrospective Studies; Vasoconstrictor Agents; Xanthines; child; creatinine; diuretics; hospitalization; methylxanthine; neonatal kidney collaborative; risk factors.
Copyright © 2019 by the American Society of Nephrology.
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Source: PubMed