Abstract
Background
To study the gestational age-specific risk factors and outcomes of severe acute kidney injury (AKI) in neonates with necrotizing enterocolitis (NEC).
Methods
Retrospective cohort study comparing gestational age (GA)-specific clinical data between infants without severe AKI (stage 0/1 AKI) and those with severe AKI (stages 2 and 3 AKI) stratified by GA ≤27 and >27 weeks.
Results
Infants with GA ≤27 weeks had double the rate of severe AKI (46.3% vs. 20%). In infants with GA >27 weeks, male sex, outborn, and nephrotoxic medication exposure were associated with severe AKI. On multivariable logistic regression, in infants with GA ≤27 weeks, surgical NEC (OR 35.08 (CI 5.05, 243.73), p < 0.001) and ostomy (OR 6.2(CI 1.29, 29.73), p = 0.027) were associated with significantly higher odds of severe AKI. Surgical NEC infants with GA >27 weeks and severe AKI were significantly more likely to be outborn, have later NEC onset, need dopamine, and have longer hospitalization (158 days [110; 220] vs.75.5 days [38.8; 105]; p = 0.007 than those with non-severe AKI.
Conclusion
In neonates with NEC, surgical intervention was associated with moderate-to-severe AKI in infants with GA ≤27 weeks and with longer hospitalization in infants with GA >27 weeks.
Impact
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In both cohorts need for surgery, stoma, cholestasis, and mechanical ventilation were associated with severe AKI; however, the infants with GA <27 weeks had twice the risk of severe AKI than GA >27 weeks group.
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The longer exposure to nephrotoxic medication and referral need were significant risk factors for AKI in GA >27 weeks group.
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GA-specific kidney protective and monitoring strategies to prevent AKI and its consequences are needed to improve the clinical outcomes in neonates with NEC. Understanding the risk factors and short- and long-term outcomes unique to different GA groups will help inform those strategies.
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Data availability
All data generated and analyzed during this study are included in this article and its supplementary information files.
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Acknowledgements
The Mississippi Center for Clinical and Translational Research for supporting NEC research.
Funding
P.M.G. and W.B.H. are partially supported by the NIGMS of the NIH under Award Number 5U54GM115428. A.M.S. has funding from the NHBLI K23-HL148394, R01-HL146818, L40-HL148910-2, and R56-HL164434. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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P.M.G. designed the study. P.M.G., I.A.P., R.R., M.A.Y.A., C.W.Y., J.G.J., A.M.S., and W.B.H. collected, analyzed the data and wrote the manuscript. All authors contributed to and approved the manuscript.
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Garg, P.M., Pittman, I.A., Ansari, M.A.Y. et al. Gestational age-specific clinical correlates of acute kidney injury in preterm infants with necrotizing enterocolitis. Pediatr Res 94, 2016–2025 (2023). https://doi.org/10.1038/s41390-023-02736-6
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DOI: https://doi.org/10.1038/s41390-023-02736-6
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