Sanjay Wazir1, Sidharth Kumar Sethi2, Gopal Agarwal1, Abhishek Tibrewal3, Rohan Dhir2, Naveen Bajaj4, Naveen Parkash Gupta5, Shishir Mirgunde6, Jagdish Sahoo7, Binesh Balachandran8, Kamran Afzal9, Anubha Shrivastava10, Jyoti Bagla11, Sushma Krishnegowda12, Ananth Konapur13, Kritika Soni2, Abhyuday Rana14, Timothy Bunchman15, Rupesh Raina16. 1. Neonatology, Cloudnine Hospital, Gurgaon, Haryana, India. 2. Pediatric Nephrology, Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India. 3. Akron's Children Hospital, Akron, OH, USA. 4. Neonatology, Deep Hospital, Ludhiana, Punjab, India. 5. Neonatology, Madhukar Rainbow Children's Hospital, New Delhi, India. 6. Government Medical College, Miraj, Maharashtra, India. 7. Department of Neonatology, IMS & SUM Hospital, Bhubaneswar, India. 8. Aster Mims Hospital, Kottakkal, Kerala, India. 9. Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim University, Uttar Pradesh, India. 10. MLM Medical College, Prayagraj, Uttar Pradesh, India. 11. ESI Post Graduate Institute of Medical Science Research, Basaidarapur, New Delhi, India. 12. JSS Hospital, JSS Academy of Higher Education and Research, Mysuru, Karnataka, India. 13. KIMS Hospital, Kurnool, Andhra Pradesh, India. 14. Kidney Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India. 15. Children's Hospital of Richmond, Richmond, VA, USA. 16. Akron's Children Hospital, Akron, OH, USA. rraina@akronchildrens.org.
Abstract
BACKGROUND: Neonates admitted in the neonatal intensive care unit are vulnerable to acute kidney injury leading to worse outcomes. It is important to identify "at-risk" neonates for early preventive measures. METHODS: The study was a multicenter, national, prospective cohort study done in 11 centers in India. A multivariable logistic regression technique with step-wise backward elimination method was used, and a "Risk Prediction Scoring" was devised [the STARZ score]. RESULTS: The neonates with admission in the NICU within <25.5 h of birth, requirement of positive pressure ventilation in the delivery room, <28 weeks gestational age, sepsis, significant cardiac disease, urine output <1.32 ml/kg/h or serum creatinine ≥0.98 mg/dl during the first 12 h post admission, use of nephrotoxic drugs, use of furosemide, or use of inotrope had a significantly higher risk of AKI at 7 days post admission in the multivariate logistic regression model. This scoring model had a sensitivity of 92.8%, specificity of 87.4% positive predictive value of 80.5%, negative predictive value of 95.6%, and accuracy of 89.4%. CONCLUSIONS: The STARZ neonatal score serves to rapidly and quantitatively determine the risk of AKI in neonates admitted to the neonatal intensive care unit. IMPACT: The STARZ neonatal score serves to rapidly and quantitatively determine the risk of AKI in neonates admitted to the neonatal intensive care unit. These neonates with a higher risk stratification score need intense monitoring and daily kidney function assessment. With this intensification of research in the field of AKI risk stratification prediction, there is hope that we will be able to decrease morbidity and mortality associated with AKI in this population.
BACKGROUND: Neonates admitted in the neonatal intensive care unit are vulnerable to acute kidney injury leading to worse outcomes. It is important to identify "at-risk" neonates for early preventive measures. METHODS: The study was a multicenter, national, prospective cohort study done in 11 centers in India. A multivariable logistic regression technique with step-wise backward elimination method was used, and a "Risk Prediction Scoring" was devised [the STARZ score]. RESULTS: The neonates with admission in the NICU within <25.5 h of birth, requirement of positive pressure ventilation in the delivery room, <28 weeks gestational age, sepsis, significant cardiac disease, urine output <1.32 ml/kg/h or serum creatinine ≥0.98 mg/dl during the first 12 h post admission, use of nephrotoxic drugs, use of furosemide, or use of inotrope had a significantly higher risk of AKI at 7 days post admission in the multivariate logistic regression model. This scoring model had a sensitivity of 92.8%, specificity of 87.4% positive predictive value of 80.5%, negative predictive value of 95.6%, and accuracy of 89.4%. CONCLUSIONS: The STARZ neonatal score serves to rapidly and quantitatively determine the risk of AKI in neonates admitted to the neonatal intensive care unit. IMPACT: The STARZ neonatal score serves to rapidly and quantitatively determine the risk of AKI in neonates admitted to the neonatal intensive care unit. These neonates with a higher risk stratification score need intense monitoring and daily kidney function assessment. With this intensification of research in the field of AKI risk stratification prediction, there is hope that we will be able to decrease morbidity and mortality associated with AKI in this population.
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Authors: Jennifer G Jetton; Louis J Boohaker; Sidharth K Sethi; Sanjay Wazir; Smriti Rohatgi; Danielle E Soranno; Aftab S Chishti; Robert Woroniecki; Cherry Mammen; Jonathan R Swanson; Shanty Sridhar; Craig S Wong; Juan C Kupferman; Russell L Griffin; David J Askenazi Journal: Lancet Child Adolesc Health Date: 2017-11