Jennifer R Charlton1, Louis Boohaker2, David Askenazi2, Patrick D Brophy3, Mamta Fuloria4, Jason Gien5, Russell Griffin2, Sangeeta Hingorani6, Susan Ingraham7, Ayesa Mian3, Robin K Ohls8, Shantanu Rastogi9, Christopher J Rhee10, Mary Revenis11, Subrata Sarkar12, Michelle Starr6, Alison L Kent3. 1. University of Virginia Children's Hospital, Charlottesville, VA, USA. jrc6n@virginia.edu. 2. University of Alabama at Birmingham, Birmingham, AL, USA. 3. Golisano Children's Hospital, University of Rochester School of Medicine, Rochester, NY, USA. 4. The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA. 5. University of Colorado, Children's Hospital Colorado, Aurora, CO, USA. 6. Seattle Children's Hospital/University of Washington, Seattle, WA, USA. 7. Kapi'olani Medical Center for Women and Children, Honolulu, HI, USA. 8. University of New Mexico, Albuquerque, NM, USA. 9. Maimonides Infants and Children's Hospital, Brooklyn, NY, USA. 10. Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA. 11. Children's National Medical Center, The George Washington University School of Medicine and The Health Sciences, Washington, DC, USA. 12. C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
Abstract
BACKGROUND: Most studies of neonatal acute kidney injury (AKI) have focused on the first week following birth. Here, we determined the outcomes and risk factors for late AKI (>7d). METHODS: The international AWAKEN study examined AKI in neonates admitted to an intensive care unit. Late AKI was defined as occurring >7 days after birth according to the KDIGO criteria. Models were constructed to assess the association between late AKI and death or length of stay. Unadjusted and adjusted odds for late AKI were calculated for each perinatal factor. RESULTS: Late AKI occurred in 202/2152 (9%) of enrolled neonates. After adjustment, infants with late AKI had higher odds of death (aOR:2.1, p = 0.02) and longer length of stay (parameter estimate: 21.9, p < 0.001). Risk factors included intubation, oligo- and polyhydramnios, mild-moderate renal anomalies, admission diagnoses of congenital heart disease, necrotizing enterocolitis, surgical need, exposure to diuretics, vasopressors, and NSAIDs, discharge diagnoses of patent ductus arteriosus, necrotizing enterocolitis, sepsis, and urinary tract infection. CONCLUSIONS: Late AKI is common, independently associated with poor short-term outcomes and associated with unique risk factors. These should guide the development of protocols to screen for AKI and research to improve prevention strategies to mitigate the consequences of late AKI.
BACKGROUND: Most studies of neonatal acute kidney injury (AKI) have focused on the first week following birth. Here, we determined the outcomes and risk factors for late AKI (>7d). METHODS: The international AWAKEN study examined AKI in neonates admitted to an intensive care unit. Late AKI was defined as occurring >7 days after birth according to the KDIGO criteria. Models were constructed to assess the association between late AKI and death or length of stay. Unadjusted and adjusted odds for late AKI were calculated for each perinatal factor. RESULTS: Late AKI occurred in 202/2152 (9%) of enrolled neonates. After adjustment, infants with late AKI had higher odds of death (aOR:2.1, p = 0.02) and longer length of stay (parameter estimate: 21.9, p < 0.001). Risk factors included intubation, oligo- and polyhydramnios, mild-moderate renal anomalies, admission diagnoses of congenital heart disease, necrotizing enterocolitis, surgical need, exposure to diuretics, vasopressors, and NSAIDs, discharge diagnoses of patent ductus arteriosus, necrotizing enterocolitis, sepsis, and urinary tract infection. CONCLUSIONS: Late AKI is common, independently associated with poor short-term outcomes and associated with unique risk factors. These should guide the development of protocols to screen for AKI and research to improve prevention strategies to mitigate the consequences of late AKI.
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