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Incidence and Risk Factors of Early Onset Neonatal AKI
Journal article   Open access   Peer reviewed

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, …
Clinical journal of the American Society of Nephrology, Vol.14(2), pp.184-195
02/07/2019
DOI: 10.2215/CJN.03670318
PMCID: PMC6390916
PMID: 34497098
url
https://doi.org/10.2215/CJN.03670318View
Published (Version of record) Open Access

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 serumcreatinine. 0.3mg/dl or urine output, 1ml/kg per hour on postnatal days 2-7, the neonatalmodification of KidneyDisease: ImprovingGlobalOutcomes criteria. We assessed risk factors forAKI and associations ofAKI with death and duration of hospitalization. ResultsTwenty-onepercent (449of 2110) experiencedearlyAKI. EarlyAKIwas associatedwithhigher riskof 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 includedmultiplegestations, cesarean section, andexposuresto 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.
 Life Sciences & Biomedicine Science & Technology Urology & Nephrology

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