Acute Kidney Injury in Newborns (original) (raw)
Related papers
Acute Kidney Injury in Sick Neonate: Incidence and Outcome
Journal of Bangladesh College of Physicians and Surgeons, 2017
Introduction: Acute kidney injury (AKI) is an important clinical problem in sick neonate. In most patients, AKI accompanies with a predisposing factor such as sepsis, asphyxia and surgery. The aims of this study were to determine the incidence, associated contributing factors and short term outcome of AKI in hospitalized newborn infants. Materials and Methods: This prospective cohort study was done in Dhaka Shishu Hospital from March 2011 to September 2011. This study included 300 sick neonates admitted during the study period. AKI was defined when serum creatinine level >1.5 mg/dl and BUN was >20 mg/dl on two separate occasions at 24 hours apart. Oliguria was defined as urine output <1ml/kg/ hr. Medical records of those patients were reviewed and data were analyzed using SPSS software. Results: Fourteen babies (4.66%) out of 300 sick neonates had AKI, of whom 64.2% were male and 35.7% female. The term and preterm neonates were 71% and 29% respectively. While a normal birth weight was observed in 57% cases, 35% had low birth weight and 7.14% had very low birth weight. Sepsis was the most common (71%) association of AKI, followed by perinatal asphyxia (52%). All patients had more than one predisposing factors. Frequency of oliguric kidney injury was 57% and non-oliguric was 43%. Mortality among the hospitalized neonate with AKI was 21%. Conclusion: This study showed that in a tertiary care hospital AKI is not uncommon (4.66%) in neonatal care unit. It is associated with some preventable conditions such as sepsis, perinatal asphyxia and shock. Outcome is poor in sick neonates with AKI (21% mortality) in comparison to sick neonates without AKI (10.3%).
The professional medical journal, 2022
A total of 257 neonates were selected having AKI and included in the study. Various causes and risk factors for AKI were assessed and patients were followed till the outcome. Results: A total of 257 patients having AKI were included and data was collected. Of the total selected newborns gender distribution was 57.97% (149/257) males and female were 42.02% (108/257). Mean age was 5.1 ± 4.6 days. 73.15% babies were delivered at term gestation and 26.84% were delivered preterm. 90.27 % babies were delivered through normal vaginal delivery and 9.7% were delivered through caesarean section. Among the total 257 included babies 27.62% were having history of hypoxic ischemic encephalopathy and 45.52% were diagnosed as sepsis on positive blood culture or septic screening. Oliguria was present in only 38.13% of the babies and urine output was normal in 61.86%. 95.71% babies were not having renal malformations. Renal profile of the babies showed with mean serum creatinine of 2.57 mg/dl. Mean sodium level was 139.16 mg/dl and mean potassium level was 3.59 mg/ dl. 26.45% of the total patients died and the mortality rate was 29% in patient having sepsis as compared to 25% of patient having hypoxic ischemic encephalopathy. Conclusion: AKI in NICU is very common and needs a proper evaluation and management strategies. Neonatologist should be aware of the various causes of AKI and should be able to diagnose it on time. In neonates having AKI, oliguria is not that much common therefore it is recommended not to wait for a decrease urine output but to screen all the high risk neonates for AKI with serum creatinine level. Mortality in neonates due to AKI was high specifically in male gender having sepsis, HIE or oliguria.
Incidence, risk factors, and outcome of neonatal acute kidney injury: a prospective cohort study
Pediatric nephrology (Berlin, Germany), 2018
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. To study the incidence and outcome of neonatal AKI in a single Saudi Arabian center, level 2\3 NICU. 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). The incidence of AKI (modified neonatal KDIGO stages) was...
Neonatal acute kidney injury in a tertiary center in a developing country
Nephrology Dialysis Transplantation, 2012
Background. Acute kidney injury (AKI) is a common contributor to morbidity and mortality in newborns, with prevalences varying by population and hospital. A study of AKI in newborns in tertiary care centers in Thailand, a developing country with limited resources, has not been conducted yet. Methods. The aim of this study was to determine the prevalence of AKI in newborns in a tertiary care hospital in southern Thailand and to investigate the etiology, mortality and risk factors of mortality. The records of patients aged <30 days with high serum creatinine, admitted from 1984 to 2007, were retrospectively reviewed. Results. Eighty-eight boys and 51 girls were enrolled; 61.4% were premature and 56.5% had a birth weight <2500 g. The prevalence of newborn AKI increased from 0.9 to 6.3% during the 24-year study period. Thirty-nine and 65% had renal failure within 2 and 7 days post-birth, respectively. Sepsis was the most common cause of AKI (30.9%) followed by hypovolemia (18.7%), kidney, ureter and bladder (KUB) anomalies (12.2%), congestive heart failure (12.2%) and birth asphyxia (11.5%). Indomethacin caused AKI in 24.4% with gestational age <32 weeks. Sepsisinduced AKI had the highest mortality rate (65.1%) with an overall mortality rate of 38.8% and nearly 14 times the risk of death compared to hypovolemia-induced AKI. Conclusions. The prevalence of newborn AKI in our Thai tertiary center over 24 years was 6.3% of admitted newborns. Sepsis was the most common cause of AKI and sepsis-induced AKI is the most common cause of death. Disease etiology was the only risk factor for mortality.
Risk factors and mortality rate in premature babies with acute kidney injury
Journal of clinical laboratory analysis, 2018
Acute kidney injury (AKI) is a common morbidity in neonatal intensive care units and associated with poor outcome. This study aimed to determine the prevalence of AKI and provide a demographic data and risk factors associated with the mortality and morbidity. This is a retrospective study included 105 premature babies. Diagnosis of AKI was based on neonatal KDIGO classification criteria. The babies were stratified into two groups according to AKI status during the hospitalization. Clinical and laboratory characteristics of the AKI group were compared to non-AKI group. AKI occurred in 21 (20.0%) of 105 premature babies, and mortality rate in these babies was 61.9%. Lower gestational weeks, lower Apgar scores at 5 minutes, lower systolic blood pressures, and inotropic supports were independent risk factors for the development of AKI in preterm babies (P < .05, for each). Oliguria, preeclampsia/eclampsia, resuscitation at birth, lower diastolic blood pressure, patent ductus arterios...
Acute kidney injury in premature newborns—definition, etiology, and outcome
Pediatric Nephrology, 2017
Background Neonatal acute kidney injury (AKI) is common and is associated with poor outcomes. New criteria for the diagnosis of AKI were introduced based on the increase in serum creatinine (SCr) levels and/or reduction of urine output (UOP). Yet, there is no generally accepted opinion so far, which criteria (whether SCr, UOP, or their combination) are the most appropriate to diagnose neonatal AKI. Methods The retrospective study included 195 prematurely born neonates who fulfilled all inclusion criteria (with at least two SCr measurements). In all the neonates included in the study, AKI was diagnosed using three different definitions: (1) SCr criteria (an increase in SCr values of ≥0.3 mg/dl), (2) UOP criteria (UOP < 1.5 ml/kg/h), and (3) SCr + UOP criteria. Results Out of all of the patients the study included, 85 (44%) were diagnosed with AKI. The neonates who had AKI had a significantly lower gestational age, birth weight, and Apgar score, longer duration of mechanical ventilation, and a higher mortality rate. SCr + UOP criteria showed higher sensitivity for prediction of death compared to SCr or UOP alone (p = 0.0008, 95% CI 0.040-0.154, and p = 0.0038, 95% CI 0.024-0.125, respectively). If only SCr or only UOP criterion are used, they fail to identify AKI in 61 and 67%, respectively. AKI was an independent risk factor for death (OR 7.4875; CI 3.1887-17.5816). Conclusions Similar to other studies, our data showed that neonates with AKI have worse outcome. Neonatal AKI defined based on SCr + UOP criteria is a better predictor of death than neonatal AKI defined based only on the SCr or UOP criteria. Also, by using SCr + UOP criteria for diagnosing neonatal AKI, more patients with AKI are recruited than when only one of those criteria is used.
Journal of Clinical Neonatology, 2014
Measurement of plasma creatinine level is the simplest and most practical mean for assessment of renal function. Th e plasma creatinine concentration immediately aft er term delivery declines gradually from 1.1 mg/dl (preterm neonate from 1.3 mg/dl) to 0.4 mg/dl during the fi rst 2 weeks of life. [8-10] Treatment of AKI includes conservative therapy, dialysis, and rarely surgery of urinary tract obstruction. In the newborns, peritoneal dialysis (PD) is preferred over other dialysis methods, especially in low-birth weight patients. [11,12] Some early outcomes observed in AKI of neonates include death and long-term hospitalization due to various
Outcome of Neonatal Acute Kidney Injury in a Special Care Baby Unit (SCABU)
Dhaka Shishu (Children) Hospital Journal
Background: Acute kidney injury (AKI) is common in neonates admitted in Special Care Baby Unit (SCABU) with high morbidity and mortality. Objective: The present study was intended to see the immediate hospital outcome of neonatal acute kidney injury (AKI) in a Special Care Baby Unit (SCABU). Methods: This observational study was carried out in SCABU, in the Department of Paediatrics, Dhaka Medical College Hospital, from October 2013 to March 2014. A total of 44 neonates (from 3-28 days) with AKI were included in this study. AKI staging was done by using pediatric RIFLE criteria as Risk, Injury, Failure. Patients were managed conservatively and immediate hospital outcome was assessed by SCABU stay, multiorgan failure, resolution of AKI, mortality and dialysis as needed. Results: Demographic profile among the study population the neonate of d”7 days old comprised the main bulk. Majority of the neonates were of average birth weight. The diagnosis was based on estimated creatinine clear...
Introduction: Reasons for acute renal failure in hospitalized infants were sepsis, hypovolemia, asphyxia, respiratory distress syndrome, surgical interventions and congenital heart defects. The aim of this study was to determine the frequency and and main etiologies, and early outcome of neonatal acute renal failure. Materials and Methods: At Intensive Care Unit, Clinical Center Tuzla, from 15. 01. 2013 to 15. 01. 2015 in 21 newborn was diagnosed renal failure, based on the amount of excreted urine and serum creatinine. Results: The prevalence of renal failure was 6.84%, with a higher incidence of female. 33.3% of infants were term neonates. Oliguria was diagnosed in 71.4% of newborns. Sepsis was the most common predisposing factor for the development of renal failure, associated with high mortality. Other causes of renal failure were perinatal hypoxia, RDS, surgical interventions and congenital heart defects. There was a positive correlation between the gestational age of the newborn and serum creatinine. Discussion: Early prevention of risk factors with rapid diagnosis and effective treatment, can affect further outcome of acute renal failure in infants. Key words: acute kidney injury, newborns, intensive care unit.
Prognostic Factors and Mortality Rate in Neonates with Acute Renal Injury in NICU
Introduction: Acute Renal Injury (AKI) is a frequent clinical condition in the Neonatal Intensive Care Units (NICUs). Most AKI causes are preventable; performing rapid preventive, diagnostic, and therapeutic measures could prevent the potential complications. The present study was conducted to define the risk factors and mortality rates of neonates with and without AKI admitted in the NICU of a tertiary care hospital. Materials and Methods: Demographic and biochemical data of NICU of Mahdieh Hospital were collected and analyzed. More than twofold increase in normal serum creatinine level or >0.8 mg/dl (for infants > 4 days age) was defined as AKI. All newborns were divided into two groups: with and without AKI. Risk factors and mortality rates were compared in the 2 groups. Results: The mortality rate of newborns with AKI was 4.5%. The other risk factors for mortality in neonates with AKI were as follows: Hyaline Membrane Disease (HMD) (P <0.03), using mechanical ventilation (P <0.041), using surfactant (P <0.04), first minute Apgar score <5, PCO2 >60 mmHg (P <0.035), birth weight < 2500 g (P <0.003) and serum creatinine (SCr) level >1 mg/dl (P <0.003). ROC Curve revealed that low birth weight was the most significant risk factor for mortality of neonates with AKI admitted in the NICU. Conclusions: Mortality related to AKI was associated with HMD, using mechanical ventilation, the need to surfactant use, low Apgar score, high blood PCO2, high serum creatinine level, and low birth weight.