Low incidence of acute kidney injury in VLBW infants with restrictive use of mechanical ventilation.
AKI
Less-invasive surfactant administration
NSAID
Nephrotoxic medication
Preterm infant
Journal
Pediatric nephrology (Berlin, Germany)
ISSN: 1432-198X
Titre abrégé: Pediatr Nephrol
Pays: Germany
ID NLM: 8708728
Informations de publication
Date de publication:
13 Nov 2023
13 Nov 2023
Historique:
received:
21
04
2023
accepted:
19
09
2023
revised:
18
09
2023
medline:
13
11
2023
pubmed:
13
11
2023
entrez:
13
11
2023
Statut:
aheadofprint
Résumé
We assessed the incidence of and risk factors for acute kidney injury (AKI) in very low birthweight infants (VLBW) in a center with a specific neonatal management protocol focusing on avoidance of early mechanical ventilation (MV). This retrospective single center analysis includes 128 infants born in 2020 with a gestational age ≥ 22 weeks who were screened for AKI using the nKDIGO criteria. AKI was identified in 25/128 patients (19.5%) with eight of them (6.3%) presenting with severe AKI. Low gestational age, birthweight and 10-minute Apgar score as well as high CRIB-1 score were all associated with incidence of AKI. Forty-five percent of the infants with MV developed AKI vs. 8.9% of those without MV (p < 0.001). Early onset of MV and administration of more than 3 dosages of NSAIDs for patent duct were identified as independent risk factors for AKI in a logistic regression analysis. We report a substantially lower frequency of AKI in VLBW infants as compared to previous studies, along with a very low rate of MV. A neonatal protocol focusing on avoidance of MV within the first days of life may be a key factor to decrease the risk of AKI in immature infants. A higher resolution version of the Graphical abstract is available as Supplementary information.
Sections du résumé
BACKGROUND
BACKGROUND
We assessed the incidence of and risk factors for acute kidney injury (AKI) in very low birthweight infants (VLBW) in a center with a specific neonatal management protocol focusing on avoidance of early mechanical ventilation (MV).
METHODS
METHODS
This retrospective single center analysis includes 128 infants born in 2020 with a gestational age ≥ 22 weeks who were screened for AKI using the nKDIGO criteria.
RESULTS
RESULTS
AKI was identified in 25/128 patients (19.5%) with eight of them (6.3%) presenting with severe AKI. Low gestational age, birthweight and 10-minute Apgar score as well as high CRIB-1 score were all associated with incidence of AKI. Forty-five percent of the infants with MV developed AKI vs. 8.9% of those without MV (p < 0.001). Early onset of MV and administration of more than 3 dosages of NSAIDs for patent duct were identified as independent risk factors for AKI in a logistic regression analysis.
CONCLUSIONS
CONCLUSIONS
We report a substantially lower frequency of AKI in VLBW infants as compared to previous studies, along with a very low rate of MV. A neonatal protocol focusing on avoidance of MV within the first days of life may be a key factor to decrease the risk of AKI in immature infants. A higher resolution version of the Graphical abstract is available as Supplementary information.
Identifiants
pubmed: 37955704
doi: 10.1007/s00467-023-06182-8
pii: 10.1007/s00467-023-06182-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2023. The Author(s).
Références
Jetton JG, Boohaker LJ, Sethi SK et al (2017) Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health 1:184–194. https://doi.org/10.1016/S2352-4642(17)30069-X
doi: 10.1016/S2352-4642(17)30069-X
pubmed: 29732396
pmcid: 5933049
De Mul A, Parvex P, Héneau A et al (2022) Urine output monitoring for the diagnosis of early-onset acute kidney injury in very preterm infants. Clin J Am Soc Nephrol 17:949–956. https://doi.org/10.2215/CJN.15231121
doi: 10.2215/CJN.15231121
pubmed: 35764392
pmcid: 9269638
Wu Y, Wang H, Pei J et al (2022) Acute kidney injury in premature and low birth weight neonates: a systematic review and meta-analysis. Pediatr Nephrol 37:275–287. https://doi.org/10.1007/s00467-021-05251-0
doi: 10.1007/s00467-021-05251-0
pubmed: 34529137
Hingorani S, Schmicker RH, Brophy PD et al (2021) Severe acute kidney injury and mortality in extremely low gestational age neonates. Clin J Am Soc Nephrol 16:862–869. https://doi.org/10.2215/CJN.18841220
doi: 10.2215/CJN.18841220
pubmed: 34117080
pmcid: 8216626
Askenazi DJ, Heagerty PJ, Schmicker RH et al (2020) Prevalence of acute kidney injury (AKI) in extremely low gestational age neonates (ELGAN). Pediatr Nephrol 35:1737–1748. https://doi.org/10.1007/s00467-020-04563-x
doi: 10.1007/s00467-020-04563-x
pubmed: 32488672
pmcid: 8093091
Harer MW, Askenazi DJ, Boohaker LJ et al (2018) Association between early caffeine citrate administration and risk of acute kidney injury in preterm neonates: results from the AWAKEN study. JAMA Pediatr 172:e180322. https://doi.org/10.1001/jamapediatrics.2018.0322
doi: 10.1001/jamapediatrics.2018.0322
pubmed: 29610830
pmcid: 6137530
Perico N, Askenazi D, Cortinovis M, Remuzzi G (2018) Maternal and environmental risk factors for neonatal AKI and its long-term consequences. Nat Rev Nephrol 14:688–703. https://doi.org/10.1038/s41581-018-0054-y
doi: 10.1038/s41581-018-0054-y
pubmed: 30224767
Lazarovits G, Ofek Shlomai N, Kheir R et al (2023) Acute kidney injury in very low birth weight infants: a major morbidity and mortality risk factor. Child (Basel) 10:242. https://doi.org/10.3390/children10020242
doi: 10.3390/children10020242
Hingorani S, Schmicker R, Ahmad KA et al (2022) Prevalence and risk factors for kidney disease and elevated BP in 2-year-old children born extremely premature. Clin J Am Soc Nephrol 17:1129–1138. https://doi.org/10.2215/CJN.15011121
doi: 10.2215/CJN.15011121
pubmed: 35853728
pmcid: 9435989
Coleman C, Tambay Perez A, Selewski DT, Steflik HJ (2022) Neonatal acute kidney injury. Front Pediatr 10:842544. https://doi.org/10.3389/fped.2022.842544
doi: 10.3389/fped.2022.842544
pubmed: 35463895
pmcid: 9021424
Gallo D, de Bijl-Marcus KA, Alderliesten T et al (2021) Early acute kidney injury in preterm and term neonates: incidence, outcome, and associated clinical features. Neonatology 118:174–179. https://doi.org/10.1159/000513666
doi: 10.1159/000513666
pubmed: 33780939
Mian AN, Guillet R, Ruck L et al (2016) Acute kidney injury in premature, very low-birth-weight infants. J Pediatr Intensive Care 5:69–78. https://doi.org/10.1055/s-0035-1564797
doi: 10.1055/s-0035-1564797
pubmed: 31110888
Mehler K, Oberthuer A, Keller T et al (2016) Survival among infants born at 22 or 23 weeks’ gestation following active prenatal and postnatal care. JAMA Pediatr 170:671–677. https://doi.org/10.1001/jamapediatrics.2016.0207
doi: 10.1001/jamapediatrics.2016.0207
pubmed: 27214875
The International Neonatal Network (1993) The CRIB (clinical risk index for babies) score: a tool for assessing initial neonatal risk and comparing performance of neonatal intensive care units. Lancet 342:193–198
doi: 10.1016/0140-6736(93)92296-6
Papile LA, Burstein J, Burstein R, Koffler H (1978) Incidence and evolution of subependymal and intraventricular hemorrhage: a study of infants with birth weights less than 1,500 gm. J Pediatr 92:529–534. https://doi.org/10.1016/s0022-3476(78)80282-0
doi: 10.1016/s0022-3476(78)80282-0
pubmed: 305471
Bell MJ, Ternberg JL, Feigin RD et al (1978) Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 187:1–7. https://doi.org/10.1097/00000658-197801000-00001
doi: 10.1097/00000658-197801000-00001
pubmed: 413500
pmcid: 1396409
Zappitelli M, Ambalavanan N, Askenazi DJ et al (2017) Developing a neonatal acute kidney injury research definition: a report from the NIDDK neonatal AKI workshop. Pediatr Res 82:569–573. https://doi.org/10.1038/pr.2017.136
doi: 10.1038/pr.2017.136
pubmed: 28604760
pmcid: 9673450
American Academy of Pediatrics Committee on Fetus and Newborn (2012) Levels of neonatal care. Pediatrics 130:587–597. https://doi.org/10.1542/peds.2012-1999
doi: 10.1542/peds.2012-1999
Mehler K, Grimme J, Abele J et al (2012) Outcome of extremely low gestational age newborns after introduction of a revised protocol to assist preterm infants in their transition to extrauterine life. Acta Paediatr 101:1232–1239. https://doi.org/10.1111/apa.12015
doi: 10.1111/apa.12015
pubmed: 23113721
Madar J, Roehr CC, Ainsworth S et al (2021) European resuscitation council guidelines 2021: newborn resuscitation and support of transition of infants at birth. Resuscitation 161:291–326. https://doi.org/10.1016/j.resuscitation.2021.02.014
doi: 10.1016/j.resuscitation.2021.02.014
pubmed: 33773829
Kuehne B, Kirchgaessner C, Becker I et al (2018) Mask continuous positive airway pressure therapy with simultaneous extrauterine placental transfusion for resuscitation of preterm infants - a preliminary study. Biomed Hub 3:1–10. https://doi.org/10.1159/000488926
doi: 10.1159/000488926
pubmed: 31988958
pmcid: 6945906
Benveniste D, Pedersen JE (1968) A valve substitute with no moving parts, for artificial ventilation in newborn and small infants. Br J Anaesth 40:464–470. https://doi.org/10.1093/bja/40.6.464
doi: 10.1093/bja/40.6.464
pubmed: 4871806
Avery ME, Fletcher BD, Williams RG (1981) The lung and its disorders in the newborn infant (volume 1 in the series Major problems in clinical pediatrics), 4th edn. W.B. Saunders, Philadelphia, pp 1–367
Wyllie JP, Gupta S (2018) Prophylactic and early targeted treatment of patent ductus arteriosus. Semin Fetal Neonatal Med 23:250–254. https://doi.org/10.1016/j.siny.2018.03.005
doi: 10.1016/j.siny.2018.03.005
pubmed: 29571706
Heinze G, Dunkler D (2017) Five myths about variable selection. Transpl Int 30:6–10. https://doi.org/10.1111/tri.12895
doi: 10.1111/tri.12895
pubmed: 27896874
Al Gadeeb K, Qaraqei M, Al Gadeeb R et al (2021) Prediction of risk factors and outcomes of neonatal acute kidney injury. J Nephrol 34:1659–1668. https://doi.org/10.1007/s40620-021-01130-x
doi: 10.1007/s40620-021-01130-x
pubmed: 34468977
Chen C-C, Lin Y-C, Wang S-T et al (2021) Temporal trends of acute kidney injury and associated risk exposures in extremely preterm infants. Clin J Am Soc Nephrol 16:1169–1177. https://doi.org/10.2215/CJN.19301220
doi: 10.2215/CJN.19301220
pubmed: 34348930
pmcid: 8455040
Kaddourah A, Basu RK, Bagshaw SM et al (2017) Epidemiology of acute kidney injury in critically ill children and young adults. N Engl J Med 376:11–20. https://doi.org/10.1056/NEJMoa1611391
doi: 10.1056/NEJMoa1611391
pubmed: 27959707
Starr MC, Boohaker L, Eldredge LC et al (2020) Acute kidney injury and bronchopulmonary dysplasia in premature neonates born less than 32 weeks’ gestation. Am J Perinatol 37:341–348. https://doi.org/10.1055/s-0039-3400311
doi: 10.1055/s-0039-3400311
pubmed: 31777046
Askenazi D, Patil NR, Ambalavanan N et al (2015) Acute kidney injury is associated with bronchopulmonary dysplasia/mortality in premature infants. Pediatr Nephrol 30:1511–1518. https://doi.org/10.1007/s00467-015-3087-5
doi: 10.1007/s00467-015-3087-5
pubmed: 25808019
pmcid: 5821263
Starr MC, Schmicker RH, Halloran BA et al (2023) Premature infants born <28 weeks with acute kidney injury have increased bronchopulmonary dysplasia rates. Pediatr Res 94:676–682. https://doi.org/10.1038/s41390-023-02514-4
doi: 10.1038/s41390-023-02514-4
pubmed: 36759749
pmcid: 10403374
Marchiset A, Jamme M (2022) When the Renal (Function) Begins to fall: a mini-review of acute kidney injury related to acute respiratory distress syndrome in critically ill patients. Front Nephrol 2:877529
doi: 10.3389/fneph.2022.877529
pubmed: 37675005
pmcid: 10479595
Alge J, Dolan K, Angelo J et al (2021) Two to tango: kidney-lung interaction in acute kidney injury and acute respiratory distress syndrome. Front Pediatr 9:744110
doi: 10.3389/fped.2021.744110
pubmed: 34733809
pmcid: 8559585
Koyner JL, Murray PT (2008) Mechanical ventilation and lung-kidney interactions. Clin J Am Soc Nephrol 3:562–570. https://doi.org/10.2215/CJN.03090707
doi: 10.2215/CJN.03090707
pubmed: 18256378
pmcid: 6631081
Douillet CD, Robinson WP, Milano PM et al (2006) Nucleotides induce IL-6 release from human airway epithelia via P2Y2 and p38 MAPK-dependent pathways. Am J Physiol Lung Cell Mol Physiol 291:L734–L746. https://doi.org/10.1152/ajplung.00389.2005
doi: 10.1152/ajplung.00389.2005
pubmed: 16632518
Nechemia-Arbely Y, Barkan D, Pizov G et al (2008) IL-6/IL-6R axis plays a critical role in acute kidney injury. J Am Soc Nephrol 19:1106–1115. https://doi.org/10.1681/ASN.2007070744
doi: 10.1681/ASN.2007070744
pubmed: 18337485
pmcid: 2396933
Göpel W, Kribs A, Ziegler A et al (2011) Avoidance of mechanical ventilation by surfactant treatment of spontaneously breathing preterm infants (AMV): an open-label, randomised, controlled trial. Lancet 378:1627–1634. https://doi.org/10.1016/S0140-6736(11)60986-0
doi: 10.1016/S0140-6736(11)60986-0
pubmed: 21963186
Kribs A, Roll C, Göpel W et al (2015) Nonintubated surfactant application vs conventional therapy in extremely preterm infants: a randomized clinical trial. JAMA Pediatr 169:723–730. https://doi.org/10.1001/jamapediatrics.2015.0504
doi: 10.1001/jamapediatrics.2015.0504
pubmed: 26053341
Mehler K, Broer A, Roll C et al (2021) Developmental outcome of extremely preterm infants is improved after less invasive surfactant application: Developmental outcome after LISA. Acta Paediatr 110:818–825. https://doi.org/10.1111/apa.15565
doi: 10.1111/apa.15565
pubmed: 32892376
Sweet DG, Carnielli VP, Greisen G et al (2023) European consensus guidelines on the management of respiratory distress syndrome: 2022 update. Neonatology 120:3–23. https://doi.org/10.1159/000528914
doi: 10.1159/000528914
pubmed: 36863329
Majed B, Bateman DA, Uy N, Lin F (2019) Patent ductus arteriosus is associated with acute kidney injury in the preterm infant. Pediatr Nephrol 34:1129–1139. https://doi.org/10.1007/s00467-019-4194-5
doi: 10.1007/s00467-019-4194-5
pubmed: 30706125
Rhone ET, Carmody JB, Swanson JR, Charlton JR (2014) Nephrotoxic medication exposure in very low birth weight infants. J Matern Fetal Neonatal Med 27:1485–1490. https://doi.org/10.3109/14767058.2013.860522
doi: 10.3109/14767058.2013.860522
pubmed: 24168068
Stoops C, Stone S, Evans E et al (2019) Baby NINJA (nephrotoxic injury negated by just-in-time action): reduction of nephrotoxic medication-associated acute kidney injury in the neonatal intensive care unit. J Pediatr 215:223-228.e6. https://doi.org/10.1016/j.jpeds.2019.08.046
doi: 10.1016/j.jpeds.2019.08.046
pubmed: 31761141
pmcid: 7393580
Harer MW, Selewski DT, Kashani K et al (2021) Improving the quality of neonatal acute kidney injury care: neonatal-specific response to the 22nd Acute Disease Quality Initiative (ADQI) conference. J Perinatol 41:185–195. https://doi.org/10.1038/s41372-020-00810-z
doi: 10.1038/s41372-020-00810-z
pubmed: 32892210