Sustained acute kidney injury as an independent risk factor for neurodevelopmental and growth outcomes in a single NICU center

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Abstract

Purpose

Acute kidney injury (AKI) is commonly seen in neonatal intensive care units (NICUs) and is potentially associated with adverse prognoses in later stages of life. Our study evaluated the impact of sustained AKI (SAKI) on both neurodevelopmental impairment (NDI) and early growth restriction (EGR) in neonates.

Methods

This case-control study retrospectively analyzed the medical records of neonates diagnosed with SAKI in the NICU of a tertiary medical center during the period from January 2007 to December 2020. Cases without subsequent follow-up and those resulting in death were excluded. We analyzed demographic, biochemical, and clinical outcome data.

Results

Of the 93 neonates with SAKI, 51 cases (54.8%) were included in this study, while 42 cases (45.2%) were excluded due to a lack of follow-up or death. An age-matched control group comprised 103 neonates, who had never experienced AKI or SAKI, were selected at random. In total, 59 (38.3%) cases were identified as NDI and 43 (27.9%) as EGR. Multivariate analysis revealed that patients with SAKI had significantly higher risks of developing NDI (odds ratio, [OR] = 4.013, p = 0.001) and EGR (OR = 4.894, p < 0.001). The AKI interval had an area under the receiver operating characteristic curve of 0.754 for NDI at 9.5 days and 0.772 for EGR at 12.5 days.

Conclusions

SAKI is an independent risk factor for both NDI and EGR in neonates. Consequently, regular monitoring, neurological development assessments, and appropriate nutritional advice are crucial to these infants who have experienced renal injury.

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Most cited references 33

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The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants. An Evidence-based Approach

Erik Jensen, Kevin Dysart, Marie G. Gantz … (2019)

Rationale: Current diagnostic criteria for bronchopulmonary dysplasia rely heavily on the level and duration of oxygen therapy, do not reflect contemporary neonatal care, and do not adequately predict childhood morbidity. Objectives: To determine which of 18 prespecified, revised definitions of bronchopulmonary dysplasia that variably define disease severity according to the level of respiratory support and supplemental oxygen administered at 36 weeks’ postmenstrual age best predicts death or serious respiratory morbidity through 18–26 months’ corrected age. Methods: We assessed infants born at less than 32 weeks of gestation between 2011 and 2015 at 18 centers of the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Measurements and Main Results: Of 2,677 infants, 683 (26%) died or developed serious respiratory morbidity. The diagnostic criteria that best predicted this outcome defined bronchopulmonary dysplasia according to treatment with the following support at 36 weeks’ postmenstrual age, regardless of prior or current oxygen therapy: no bronchopulmonary dysplasia, no support (n = 773); grade 1, nasal cannula ≤2 L/min (n = 1,038); grade 2, nasal cannula >2 L/min or noninvasive positive airway pressure (n = 617); and grade 3, invasive mechanical ventilation (n = 249). These criteria correctly predicted death or serious respiratory morbidity in 81% of study infants. Rates of this outcome increased stepwise from 10% among infants without bronchopulmonary dysplasia to 77% among those with grade 3 disease. A similar gradient (33–79%) was observed for death or neurodevelopmental impairment. Conclusions: The definition of bronchopulmonary dysplasia that best predicted early childhood morbidity categorized disease severity according to the mode of respiratory support administered at 36 weeks’ postmenstrual age, regardless of supplemental oxygen use.

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Classifying AKI by Urine Output versus Serum Creatinine Level.

John A. Kellum, Florentina E Sileanu, Raghavan Murugan … (2015)

Severity of AKI is determined by the magnitude of increase in serum creatinine level or decrease in urine output. However, patients manifesting both oliguria and azotemia and those in which these impairments are persistent are more likely to have worse disease. Thus, we investigated the relationship of AKI severity and duration across creatinine and urine output domains with the risk for RRT and likelihood of renal recovery and survival using a large, academic medical center database of critically ill patients. We analyzed electronic records from 32,045 patients treated between 2000 and 2008, of which 23,866 (74.5%) developed AKI. We classified patients by levels of serum creatinine and/or urine output according to Kidney Disease Improving Global Outcomes staging criteria for AKI. In-hospital mortality and RRT rates increased from 4.3% and 0%, respectively, for no AKI to 51.1% and 55.3%, respectively, when serum creatinine level and urine output both indicated stage 3 AKI. Both short- and long-term outcomes were worse when patients had any stage of AKI defined by both criteria. Duration of AKI was also a significant predictor of long-term outcomes irrespective of severity. We conclude that short- and long-term risk of death or RRT is greatest when patients meet both the serum creatinine level and urine output criteria for AKI and when these abnormalities persist.

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Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study

Jennifer G. Jetton, Louis J. Boohaker, Sidharth Sethi … (2017)

Background Single-center studies suggest that neonatal acute kidney injury (AKI) is associated with poor outcomes. However, inferences regarding the association between AKI, mortality, and hospital length of stay are limited due to the small sample size of those studies. In order to determine whether neonatal AKI is independently associated with increased mortality and longer hospital stay, we analyzed the Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN) database. Methods All neonates admitted to 24 participating neonatal intensive care units from four countries (Australia, Canada, India, United States) between January 1 and March 31, 2014, were screened. Of 4273 neonates screened, 2022 (47·3%) met study criteria. Exclusion criteria included: no intravenous fluids ≥48 hours, admission ≥14 days of life, congenital heart disease requiring surgical repair at <7 days of life, lethal chromosomal anomaly, death within 48 hours, inability to determine AKI status or severe congenital kidney abnormalities. AKI was defined using a standardized definition —i.e., serum creatinine rise of ≥0.3 mg/dL (26.5 mcmol/L) or ≥50% from previous lowest value, and/or if urine output was <1 mL/kg/h on postnatal days 2 to 7. Findings Incidence of AKI was 605/2022 (29·9%). Rates varied by gestational age groups (i.e., ≥22 to <29 weeks =47·9%; ≥29 to <36 weeks =18·3%; and ≥36 weeks =36·7%). Even after adjusting for multiple potential confounding factors, infants with AKI had higher mortality compared to those without AKI [(59/605 (9·7%) vs. 20/1417 (1·4%); p< 0.001; adjusted OR=4·6 (95% CI=2·5–8·3); p=<0·0001], and longer hospital stay [adjusted parameter estimate 8·8 days (95% CI=6·1–11·5); p<0·0001]. Interpretation Neonatal AKI is a common and independent risk factor for mortality and longer hospital stay. These data suggest that neonates may be impacted by AKI in a manner similar to pediatric and adult patients. Funding US National Institutes of Health, University of Alabama at Birmingham, Cincinnati Children’s, University of New Mexico.

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Author and article information

Contributors

Mei-Ching Yu: mc.yu@cgmh.org.tw

Journal

Journal ID (nlm-ta): BMC Pediatr

Journal ID (iso-abbrev): BMC Pediatr

Title: BMC Pediatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2431

Publication date (Electronic): 2 April 2024

Publication date PMC-release: 2 April 2024

Publication date Collection: 2024

Volume: 24

Electronic Location Identifier: 233

Affiliations

[1 ]GRID grid.454211.7, ISNI 0000 0004 1756 999X, Department of Pediatric Nephrology, , Lin-Kou Chang Gung Memorial Hospital, ; Taoyuan, Taiwan

[2 ]GRID grid.454211.7, ISNI 0000 0004 1756 999X, Department of Pediatric General Medicine, , Lin-Kou Chang Gung Memorial Hospital, ; Taoyuan, Taiwan

[3 ]GRID grid.454211.7, ISNI 0000 0004 1756 999X, Department of Neonatology, , Lin-Kou Chang Gung Memorial Hospital, ; Taoyuan, Taiwan

[4 ]Department of Pediatrics, Shuang Ho Hospital, Taipei Medical University, ( https://ror.org/05031qk94) New Taipei, Taiwan

[5 ]Department of Pediatrics, School of Medicine, College of Medicine, Taipei Medical University, ( https://ror.org/05031qk94) Taipei, Taiwan

[6 ]GRID grid.454211.7, ISNI 0000 0004 1756 999X, Department of Neonatal Intensive Care Unit, , Lin-Kou Chang Gung Memorial Hospital, ; Taoyuan, Taiwan

[7 ]GRID grid.454211.7, ISNI 0000 0004 1756 999X, Department of Pharmacy Administration, , Lin-Kou Chang Gung Memorial Hospital, ; Taoyuan, Taiwan

[8 ]GRID grid.145695.a, ISNI 0000 0004 1798 0922, College of Medicine, , Chang Gung University, ; Taoyuan, Taiwan

[9 ]GRID grid.145695.a, ISNI 0000 0004 1798 0922, Department of Pediatric Nephrology, , Lin-Kou Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, ; 5 Fusing Street, Gueishan, Taoyuan, 333 Taiwan

Article

Publisher ID: 4568

DOI: 10.1186/s12887-024-04568-7

PMC ID: 10985966

SO-VID: 13c6e271-979c-4a8c-bff2-4ee91cbc77a1

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 28 September 2023

Date accepted : 15 January 2024

Funding

Funded by: Lin-Kou Chang Gung Memorial Hospital

Award ID: CMRPG3K0491

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ScienceOpen disciplines: Pediatrics

Keywords: acute kidney injury,neurodevelopment impairment,early growth restriction,neonatal intensive care unit

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ScienceOpen disciplines: Pediatrics

Keywords: acute kidney injury, neurodevelopment impairment, early growth restriction, neonatal intensive care unit

Sustained acute kidney injury as an independent risk factor for neurodevelopmental and growth outcomes in a single NICU center

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Pediatric Pulse: Advancing Neonatal and Child Health

Most cited references 33

The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants. An Evidence-based Approach

Classifying AKI by Urine Output versus Serum Creatinine Level.

Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study

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