Mohamed A Shalaby1, Zinab A Sawan2, Esraa Nawawi3, Saad Alsaedi4, Heidi Al-Wassia4, Jameela A Kari1. 1. Pediatric Nephrology Center of Excellence, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia. 2. Department of Pediatrics, King Abdulaziz University, PO Box 80215, Jeddah, 21589, Kingdom of Saudi Arabia. zenab.a.sawan@gmail.com. 3. Department of Pediatrics, King Abdulaziz University, PO Box 80215, Jeddah, 21589, Kingdom of Saudi Arabia. 4. Neonatal Intensive Care Unit, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
Abstract
BACKGROUND: Acute kidney injury (AKI) is common in neonates admitted to the neonatal intensive care unit (NICU). AKI is associated with increased morbidity and mortality and a greater long-term risk of chronic kidney disease. OBJECTIVES: To study the incidence and outcome of neonatal AKI in a single Saudi Arabian center, level 2\3 NICU. METHODS: This single-center prospective cohort study included all infants who received level II or III NICU care during 2015 (January to December). We excluded infants who survived less than 48 h after admission, had evidence of congenital renal anomalies, or had insufficient data. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Both AKI and non-AKI neonates were prospectively followed up until NICU discharge. Outcomes studied included mortality and length of NICU stay. The results of adjusted risk analyses were expressed as relative risk (RR) with 95% confidence interval (95% CI). RESULTS: The incidence of AKI (modified neonatal KDIGO stages) was 56% (120/214 patients). Compared with neonates without AKI, those with AKI had a lower birth weight (2202 ± 816 vs. 1570 ± 776 g; p < 0.001) and a lower gestational age (35 ± 3 vs. 32 ± 4 weeks; p < 0.001). After adjustment for potential confounders, only gestational age (RR, 4.8; 95% CI, 3-9) and perinatal depression (RR, 10; 95% CI, 2-46) were significantly associated with an increased risk of AKI. For infants with gestational age < 32 weeks, only the Clinical Risk Index for Babies (CRIB II) score was associated with an increased risk of AKI (RR, 1.9; 95% CI, 1-3). After adjustment for gestational age, AKI was significantly associated with mortality (RR, 5.4; 95% CI, 2-14), but not with the length of hospital stay (LOS) (p = 0.133). However, the AKI group had a significantly longer LOS (mean difference: 14 days; 95% CI, 5.5-23 days), and 33 patients (27.5%) with AKI were discharged with abnormally high serum creatinine levels (> 65 μmol/L). CONCLUSION: AKI occurred in more than half of all NICU admissions, was associated with an increased risk of mortality, and had a higher incidence among smaller and sicker infants. Therefore, close monitoring of renal function during hospitalization and after discharge is warranted in such infants.
BACKGROUND:Acute kidney injury (AKI) is common in neonates admitted to the neonatal intensive care unit (NICU). AKI is associated with increased morbidity and mortality and a greater long-term risk of chronic kidney disease. OBJECTIVES: To study the incidence and outcome of neonatal AKI in a single Saudi Arabian center, level 2\3 NICU. METHODS: This single-center prospective cohort study included all infants who received level II or III NICU care during 2015 (January to December). We excluded infants who survived less than 48 h after admission, had evidence of congenital renal anomalies, or had insufficient data. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Both AKI and non-AKI neonates were prospectively followed up until NICU discharge. Outcomes studied included mortality and length of NICU stay. The results of adjusted risk analyses were expressed as relative risk (RR) with 95% confidence interval (95% CI). RESULTS: The incidence of AKI (modified neonatal KDIGO stages) was 56% (120/214 patients). Compared with neonates without AKI, those with AKI had a lower birth weight (2202 ± 816 vs. 1570 ± 776 g; p < 0.001) and a lower gestational age (35 ± 3 vs. 32 ± 4 weeks; p < 0.001). After adjustment for potential confounders, only gestational age (RR, 4.8; 95% CI, 3-9) and perinatal depression (RR, 10; 95% CI, 2-46) were significantly associated with an increased risk of AKI. For infants with gestational age < 32 weeks, only the Clinical Risk Index for Babies (CRIB II) score was associated with an increased risk of AKI (RR, 1.9; 95% CI, 1-3). After adjustment for gestational age, AKI was significantly associated with mortality (RR, 5.4; 95% CI, 2-14), but not with the length of hospital stay (LOS) (p = 0.133). However, the AKI group had a significantly longer LOS (mean difference: 14 days; 95% CI, 5.5-23 days), and 33 patients (27.5%) with AKI were discharged with abnormally high serum creatinine levels (> 65 μmol/L). CONCLUSION: AKI occurred in more than half of all NICU admissions, was associated with an increased risk of mortality, and had a higher incidence among smaller and sicker infants. Therefore, close monitoring of renal function during hospitalization and after discharge is warranted in such infants.
Entities:
Keywords:
AKI; Length of hospital stay; Mortality; NICU; Outcome
Authors: Michael Zappitelli; Namasivayam Ambalavanan; David J Askenazi; Marva M Moxey-Mims; Paul L Kimmel; Robert A Star; Carolyn L Abitbol; Patrick D Brophy; Guillermo Hidalgo; Mina Hanna; Catherine M Morgan; Tonse N K Raju; Patricio Ray; Zayhara Reyes-Bou; Amani Roushdi; Stuart L Goldstein Journal: Pediatr Res Date: 2017-07-11 Impact factor: 3.756
Authors: Fatih Bolat; Serdar Comert; Guher Bolat; Oznur Kucuk; Emrah Can; Ali Bulbul; Hasan Sinan Uslu; Asiye Nuhoglu Journal: World J Pediatr Date: 2013-11-14 Impact factor: 2.764
Authors: Ravindra L Mehta; John A Kellum; Sudhir V Shah; Bruce A Molitoris; Claudio Ronco; David G Warnock; Adeera Levin Journal: Crit Care Date: 2007 Impact factor: 9.097
Authors: Keia R Sanderson; Bradley Warady; William Carey; Veeral Tolia; Marcella H Boynton; Daniel K Benjamin; Wesley Jackson; Matthew Laughon; Reese H Clark; Rachel G Greenberg Journal: J Pediatr Date: 2021-11-16 Impact factor: 4.406
Authors: Sangeeta Hingorani; Robert H Schmicker; Patrick D Brophy; Patrick J Heagerty; Sandra E Juul; Stuart L Goldstein; David Askenazi Journal: Clin J Am Soc Nephrol Date: 2021-06-11 Impact factor: 10.614
Authors: Margaret Pulju; Cassandra Pruitt; Jessica Reid-Adam; Emily Spear; Annemarie Stroustrup; Robert S Green; Andrea S Weintraub Journal: J Perinatol Date: 2021-05-25 Impact factor: 3.225
Authors: Rami H Al-Rifai; Nasloon Ali; Esther T Barigye; Amal H I Al Haddad; Fatima Al-Maskari; Tom Loney; Luai A Ahmed Journal: Syst Rev Date: 2020-01-16