Incidence and Risk Factors of Early Onset Neonatal AKI.
Acute Kidney Injury
Anti-Infective Agents
Cesarean Section
Children
Epinephrine
Gestational Age
Hyperbilirubinemia
Incidence
Infant
Intensive Care Units
Mating Factor
Neonatal
Newborn
Pregnancy
Retrospective Studies
Vasoconstrictor Agents
Xanthines
child
creatinine
diuretics
hospitalization
methylxanthine
neonatal kidney collaborative
risk factors
Journal
Clinical journal of the American Society of Nephrology : CJASN
ISSN: 1555-905X
Titre abrégé: Clin J Am Soc Nephrol
Pays: United States
ID NLM: 101271570
Informations de publication
Date de publication:
07 02 2019
07 02 2019
Historique:
received:
22
03
2018
accepted:
05
10
2018
entrez:
19
11
2019
pubmed:
19
11
2019
medline:
14
5
2020
Statut:
ppublish
Résumé
Neonatal 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. The 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. Twenty-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 duration of hospitalization (parameter estimate: 7.3 days 95% confidence interval, 4.7 to 10.0), adjusting for neonatal and maternal factors along with medication exposures. Factors associated with a higher risk of AKI included: outborn delivery; resuscitation with epinephrine; admission diagnosis of hyperbilirubinemia, inborn errors of metabolism, or surgical need; frequent kidney function surveillance; and admission to a children's hospital. Those factors that were associated with a lower risk included multiple gestations, cesarean section, and exposures to antimicrobials, methylxanthines, diuretics, and vasopressors. Risk factors varied by gestational age strata. AKI in the first postnatal week is common and associated with death and longer duration of hospitalization. The AWAKEN study demonstrates a number of specific risk factors that should serve as "red flags" for clinicians at the initiation of the neonatal intensive care unit course.
Sections du résumé
BACKGROUND AND OBJECTIVES
Neonatal 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, & MEASUREMENTS
The 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.
RESULTS
Twenty-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 duration of hospitalization (parameter estimate: 7.3 days 95% confidence interval, 4.7 to 10.0), adjusting for neonatal and maternal factors along with medication exposures. Factors associated with a higher risk of AKI included: outborn delivery; resuscitation with epinephrine; admission diagnosis of hyperbilirubinemia, inborn errors of metabolism, or surgical need; frequent kidney function surveillance; and admission to a children's hospital. Those factors that were associated with a lower risk included multiple gestations, cesarean section, and exposures to antimicrobials, methylxanthines, diuretics, and vasopressors. Risk factors varied by gestational age strata.
CONCLUSIONS
AKI in the first postnatal week is common and associated with death and longer duration of hospitalization. The AWAKEN study demonstrates a number of specific risk factors that should serve as "red flags" for clinicians at the initiation of the neonatal intensive care unit course.
Identifiants
pubmed: 31738181
pii: 01277230-201902000-00007
doi: 10.2215/CJN.03670318
pmc: PMC6390916
doi:
Banques de données
ClinicalTrials.gov
['NCT02443389']
Types de publication
Journal Article
Multicenter Study
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
184-195Subventions
Organisme : NIDDK NIH HHS
ID : R01 DK110622
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001449
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK111861
Pays : United States
Organisme : NIDDK NIH HHS
ID : T32 DK007662
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK103608
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR001417
Pays : United States
Organisme : NIDDK NIH HHS
ID : P50 DK096373
Pays : United States
Investigateurs
Namasivayam Ambalavanan
(N)
David T Selewski
(DT)
Jeffery Fletcher
(J)
Carolyn L Abitbol
(CL)
Ronnie Guillet
(R)
Marissa DeFreitas
(M)
Shahnaz Duara
(S)
Erin Rademacher
(E)
Maroun J Mhanna
(MJ)
Rupesh Raina
(R)
Deepak Kumar
(D)
Ayse Akcan Arikan
(AA)
Stuart L Goldstein
(SL)
Amy T Nathan
(AT)
Juan C Kupferman
(JC)
Alok Bhutada
(A)
Elizabeth Bonachea
(E)
John Mahan
(J)
Arwa Nada
(A)
Jennifer Jetton
(J)
Tarah T Colaizy
(TT)
Jonathan M Klein
(JM)
F Sessions Cole
(FS)
T Keefe Davis
(TK)
Joshua Dower
(J)
Lawrence Milner
(L)
Kimberly Reidy
(K)
Frederick J Kaskel
(FJ)
Katja M Gist
(KM)
Mina H Hanna
(MH)
Craig S Wong
(CS)
Catherine Joseph
(C)
Tara DuPont
(T)
Amy Staples
(A)
Surender Khokhar
(S)
Sofia Perazzo
(S)
Patricio E Ray
(PE)
Cherry Mammen
(C)
Anne Synnes
(A)
Pia Wintermark
(P)
Michael Zappitelli
(M)
Sidharth K Sethi
(SK)
Sanjay Wazir
(S)
Smriti Rohatgi
(S)
Danielle E Soranno
(DE)
Aftab S Chishti
(AS)
Robert Woroniecki
(R)
Jonathan R Swanson
(JR)
Shanty Sridhar
(S)
Informations de copyright
Copyright © 2019 by the American Society of Nephrology.
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