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Patterns of acute kidney and hepatic injury and association with adverse outcomes in infants undergoing therapeutic hypothermia for hypoxic ischemic encephalopathy

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Abstract

Objective

To describe patterns of renal and hepatic injury in infants with hypoxic ischemic encephalopathy (HIE).

Study design

Retrospective cohort of infants receiving therapeutic hypothermia for HIE was classified into groups based on organ injury: neither acute kidney injury (AKI) nor acute hepatic injury (AHI), isolated AKI, isolated AHI, or both AKI/AHI. Biomarkers and outcomes were described and analyzed.

Results

Among 188 infants, 55% had no AKI nor AHI, 7% had only AKI, 22% had only AHI and 16% had both AKI and AHI. Infants with both AKI/AHI had the highest mortality (47%) and worse outcomes, compared to other injury groups, although AKI/AHI was not significantly associated with mortality (hazard ratio 2.5; 95% CI 0.9-6.9), after accounting for severity of HIE. For surviving infants, biomarkers of organ injury, on average, normalized by discharge.

Conclusion

Infants with HIE with both AKI/AHI have worse outcomes than infants with AKI or AHI alone.

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Fig. 1: Trends over time in renal biomarkers.
Fig. 2: Trends over time in hepatic biomarkers.

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Author notes

  1. These authors contributed equally: Elizabeth Karen Sewell, Shannon E. G Hamrick.

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA

    Anna Kathryn Modisett, Ravi Mangal Patel, Elizabeth Karen Sewell & Shannon E. G. Hamrick

  2. Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Anna Kathryn Modisett, Ravi Mangal Patel, Stephanie M. Jernigan, Janet Figueroa, Elizabeth Karen Sewell & Shannon E. G. Hamrick

  3. Division of Nephrology, Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA

    Stephanie M. Jernigan

  4. Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, USA

    Janet Figueroa

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Contributions

AKM conceptualized and designed the study, drafted, reviewed, and revised the initial manuscript, and approved the final manuscript as submitted. SH and ES conceptualized and designed the study, reviewed the initial manuscript, and approved the final manuscript as submitted. RMP conceptualized and designed the study, performed statistical analysis, and approved the final manuscript as submitted. SJ reviewed the initial manuscript and approved the final manuscript as submitted. JF performed statistical analysis and approved the final manuscript as submitted.

Corresponding author

Correspondence to Shannon E. G. Hamrick.

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Modisett, A.K., Patel, R.M., Jernigan, S.M. et al. Patterns of acute kidney and hepatic injury and association with adverse outcomes in infants undergoing therapeutic hypothermia for hypoxic ischemic encephalopathy. J Perinatol 42, 1361–1367 (2022). https://doi.org/10.1038/s41372-022-01394-6

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  • DOI: https://doi.org/10.1038/s41372-022-01394-6

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