Frequency of various causes of acute kidney injury in neonates in a tertiary care hospital neonatal intensive care (original) (raw)
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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%).
Incidence and Risk Factors of Early Onset Neonatal AKI
Clinical Journal of the American Society of Nephrology, 2019
Background and objectivesNeonatal AKI is associated with poor short- and long-term outcomes. The objective of this study was to describe the risk factors and outcomes of neonatal AKI in the first postnatal week.Design, setting, participants, & measurementsThe international retrospective observational cohort study, Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN), included neonates admitted to a neonatal intensive care unit who received at least 48 hours of intravenous fluids. Early AKI was defined by an increase in serum creatinine >0.3 mg/dl or urine output <1 ml/kg per hour on postnatal days 2–7, the neonatal modification of Kidney Disease: Improving Global Outcomes criteria. We assessed risk factors for AKI and associations of AKI with death and duration of hospitalization.ResultsTwenty-one percent (449 of 2110) experienced early AKI. Early AKI was associated with higher risk of death (adjusted odds ratio, 2.8; 95% confidence interval, 1.7 to 4.7) and longer du...
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.
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.
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.
A study of Acute Kidney Injury (AKI) in Neonatal Sepsis 1
Objectives: Neonatal sepsis is an important cause of morbidity and mortality especially among LBW and preterm babies. There is paucity of data on AKI in neonatal sepsis. The aim of the study was to evaluate the incidence of AKI in neonatal sepsis and delineate the risk factors associated with it. Methodology: The prospective study was conducted from May 2006-June 2009 in NICU at SVPPGIP and S.C.B. Medical College. A total of 120 cases with neonatal septicemia without gross congenital anomaly of genitourinary tract were included in the study on the basis of either a positive sepsis screen and/or a positive blood culture. AKI was diagnosed based on serum creatinine level >1.5mg/dl. The demographic profile, clinical features, etiology, underlying risk factors and outcome were analyzed in the study. Results: Out of 120 neonates 62% were male baby and with mean gestational age of 35.94weeks.16% (n=19) were VLBW and 46.2% (n=55) were LBW babies. AKI was found in 27.5 % (n=33) cases and majority of cases (n=26) were non-oliguric (urine output >1ml/kg/hour) with mean day of presentation was 1.36days. DIC and shock were present in 64% (n=21) out of 33 cases with AKI and 27.2% out of 87 (n=15) cases without AKI. Mortality was higher with non-oliguric AKI and the mean day of recovery was 4.31 days. Septic neonates with AKI were associated with higher mortality (54.5%) than those without AKI (24.1%). Conclusion: AKI is a very common entity among septic neonates. LBW is an important risk factor and coexisting shock and DIC were significantly associated for the development of AKI. Majority of septic newborns develop AKI in the first two days and are non-oliguric. This stress the need for septic neonates to be screened for AKI.
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
Neonatal Acute Kidney Injury: Diagnostic and Therapeutic Challenges
Journal of Nephrology Research
critical item in neonatal care, the special precautions regarding drugs use in neonates and renal replacement therapy in neonates which is not only technically difficult, but also associated with high rates of complications all yields AKI management in neonates to be a great challenge.