Nephrotoxic medications and acute kidney injury risk factors in the neonatal intensive care unit: clinical challenges for neonatologists and nephrologists

  • Heidi J. Murphy
  • Brady Thomas
  • Brynna Van Wyk
  • Sarah B. Tierney
  • David T. Selewski
  • Jennifer G. JettonEmail author
Educational Review
Part of the following topical collections:
  1. What’s new in AKI


Neonatal acute kidney injury (AKI) is common. Critically ill neonates are at risk for AKI for many reasons including the severity of their underlying illnesses, prematurity, and nephrotoxic medications. In this educational review, we highlight four clinical scenarios in which both the illness itself and the medications indicated for their treatment are risk factors for AKI: sepsis, perinatal asphyxia, patent ductus arteriosus, and necrotizing enterocolitis. We review the available evidence regarding medications commonly used in the neonatal period with known nephrotoxic potential, including gentamicin, acyclovir, indomethacin, vancomycin, piperacillin–tazobactam, and amphotericin. We aim to illustrate the complexity of decision-making involved for both neonatologists and pediatric nephrologists when managing infants with these conditions and advocate for ongoing multidisciplinary collaboration in the development of better AKI surveillance protocols and AKI mitigation strategies to improve care for these vulnerable patients.


Nonsteroidal anti-inflammatory drugs Antibiotics Hypoxic ischemic encephalopathy Patent ductus arteriosus Neonatal sepsis Necrotizing enterocolitis 



The authors thank Liza Kramer, PharmD Candidate, Class of 2019, University of Iowa College of Pharmacy; and Whitni Patterson, Pharm D Candidate, Class of 2019, University of Iowa College of Pharmacy.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflicts of interest.


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© IPNA 2019

Authors and Affiliations

  1. 1.Department of PediatricsMedical University of South CarolinaCharlestonUSA
  2. 2.Stead Family Department of Pediatrics, Division of NeonatologyUniversity of IowaIowa CityUSA
  3. 3.Stead Family Department of Pediatrics, Division of Nephrology, Dialysis, and TransplantationUniversity of IowaIowa CityUSA
  4. 4.Department of Pharmaceutical CareUniversity of Iowa Stead Family Children’s HospitalIowa CityUSA

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