Pediatric Nephrology

, Volume 28, Issue 4, pp 661–666 | Cite as

Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate

  • David J. Askenazi
  • Rajesh Koralkar
  • Hayden E. Hundley
  • Angela Montesanti
  • Neha Patil
  • Namasivayam Ambalavanan
Original Article



Acute kidney injury (AKI) is common and portends mortality in several neonatal cohorts. Fluid overload is independently associated with poor outcomes in children and adults but has not been extensively studied in neonates.


Between February 2010 and May 2011, we followed 58 neonates who met the following criteria: birth weight >2,000 g, gestational age ≥34 weeks, 5-min Apgar ≤7, and parental consent. Serum creatinine (SCr) was measured daily for first 4 days of life. AKI was defined as a rise in SCr of > 0.3 mg/dl or persistent SCr above 1.5 mg/dl.


AKI was present in 9/58 (15.6 %) neonates and was associated with higher birth weight, being male, lower 5-min Apgar scores, lower cord pH, delivery room intubation, and absence of maternal pre-eclampsia. Percent weight accumulation at day 3 of life was higher in those with AKI [median = 8.2, interquartile range (IQR) = 4.4–21.6)] than without AKI (median = −4 (IQR = −6.5 to 0.0) (p < 0.001). Infants with AKI had lower survival rates than those without AKI [7/9 (72 %) vs. 49/49 (100 %) (p < 0.02)].


AKI incidence in this neonatal population is similar to other neonatal cohorts. Near-term/term infants with AKI have a higher mortality rate and a net positive fluid balance over the first few days of life.


Epidemiology Acute renal failure Fluid overload Mortality Infant 


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Copyright information

© IPNA 2012

Authors and Affiliations

  • David J. Askenazi
    • 1
    • 5
  • Rajesh Koralkar
    • 2
  • Hayden E. Hundley
    • 3
  • Angela Montesanti
    • 4
  • Neha Patil
    • 1
  • Namasivayam Ambalavanan
    • 1
  1. 1.Department of PediatricsUniversity of Alabama at BirminghamBirminghamUSA
  2. 2.Department of Public HealthUniversity of Alabama at BirminghamBirminghamUSA
  3. 3.University of South Alabama, College of MedicineBirminghamUSA
  4. 4.Georgia State University Institute of Public Health, Center for Healthy DevelopmentBirminghamUSA
  5. 5.Department of Pediatrics, Division of NephrologyUniversity of Alabama at BirminghamBirminghamUSA

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