Tahagod H Mohamed1,2,3, Brett Klamer4,5,6, John D Mahan4,7,8, John D Spencer4,7,8,5, Jonathan L Slaughter8,9,10. 1. Division of Nephrology and Hypertension, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, USA. Tahagod.Mohamed@Nationwidechildrens.org. 2. Nephrology and Urology Research Affinity Group, Nationwide Children's Hospital, Columbus, OH, USA. Tahagod.Mohamed@Nationwidechildrens.org. 3. Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, USA. Tahagod.Mohamed@Nationwidechildrens.org. 4. Division of Nephrology and Hypertension, Nationwide Children's Hospital, 700 Children's Dr, Columbus, OH, USA. 5. The Center of Clinical and Translational Research, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, OH, USA. 6. Center for Biostatistics, The Ohio State University College of Medicine, Columbus, OH, USA. 7. Nephrology and Urology Research Affinity Group, Nationwide Children's Hospital, Columbus, OH, USA. 8. Department of Pediatrics, The Ohio State University College of Medicine and Nationwide Children's Hospital, Columbus, OH, USA. 9. The Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA. 10. Division of Epidemiology, College of Public Health, The Ohio State University College of Medicine, Columbus, Ohio, USA.
Abstract
BACKGROUND: Acute kidney injury (AKI) in preterm infants is associated with prolonged hospitalization and high mortality. Diuretic therapy has been used to enhance urine output in preterm infants with AKI. Treatment with diuretics, prescription patterns, and relationship with length of stay (LOS), mechanical ventilation (MV), and mortality in preterm infants who also had AKI have not been fully evaluated. METHODS: This multicenter retrospective study used the Pediatric Hospital Information System database. We included 2121 preterm infants with AKI diagnosis from 46 hospital Neonatal Intensive Care Units (NICUs) born <37 weeks gestational age (GA). Treatment with diuretics, practice patterns across 46 NICUs in the USA, and associated outcomes including LOS, MV, and mortality were evaluated. RESULTS: Seventy-six percent of infants received at least one dose of diuretics (median treatment 18 days). Diuretic prescription varied significantly across hospitals and ranged from 42 to 96%. Diuretics were used more frequently in infants with younger GA and smaller birth weight. Infants with older GA who received diuretics at or before 28 days postnatally had worse survival even after adjusting for known confounders. CONCLUSIONS: Preterm infants with AKI diagnosis were frequently treated with diuretics. Moreover, infants with younger GA and smaller birth weight were more likely to receive diuretics. Worse survival in infants with older GA who received diuretics could be the result of more underlying severe illness in these infants and not the cause of more severe illness. Prospective studies are needed to best determine patient safety and outcomes with diuretic treatment in preterm infants with AKI. A higher resolution version of the Graphical abstract is available as Supplementary information.
BACKGROUND: Acute kidney injury (AKI) in preterm infants is associated with prolonged hospitalization and high mortality. Diuretic therapy has been used to enhance urine output in preterm infants with AKI. Treatment with diuretics, prescription patterns, and relationship with length of stay (LOS), mechanical ventilation (MV), and mortality in preterm infants who also had AKI have not been fully evaluated. METHODS: This multicenter retrospective study used the Pediatric Hospital Information System database. We included 2121 preterm infants with AKI diagnosis from 46 hospital Neonatal Intensive Care Units (NICUs) born <37 weeks gestational age (GA). Treatment with diuretics, practice patterns across 46 NICUs in the USA, and associated outcomes including LOS, MV, and mortality were evaluated. RESULTS: Seventy-six percent of infants received at least one dose of diuretics (median treatment 18 days). Diuretic prescription varied significantly across hospitals and ranged from 42 to 96%. Diuretics were used more frequently in infants with younger GA and smaller birth weight. Infants with older GA who received diuretics at or before 28 days postnatally had worse survival even after adjusting for known confounders. CONCLUSIONS: Preterm infants with AKI diagnosis were frequently treated with diuretics. Moreover, infants with younger GA and smaller birth weight were more likely to receive diuretics. Worse survival in infants with older GA who received diuretics could be the result of more underlying severe illness in these infants and not the cause of more severe illness. Prospective studies are needed to best determine patient safety and outcomes with diuretic treatment in preterm infants with AKI. A higher resolution version of the Graphical abstract is available as Supplementary information.
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