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

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Abstract

Background

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.

Methods

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.

Results

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)].

Conclusions

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.

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Funding source

This study was supported by grants provided by the American Society of Nephrology Career Development Grant, the Kaul Pediatric Research Institute and a pilot and feasibility grant from the NIH-sponsored O’Brien Center for Acute Kidney Injury Research (www.obrienaki.org). Dr. Askenazi is a consultant and serves as a speaker for Gambro Renal Products.

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Authors and Affiliations

  1. Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA

    David J. Askenazi, Neha Patil & Namasivayam Ambalavanan

  2. Department of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA

    Rajesh Koralkar

  3. University of South Alabama, College of Medicine, Birmingham, AL, USA

    Hayden E. Hundley

  4. Georgia State University Institute of Public Health, Center for Healthy Development, Birmingham, AL, USA

    Angela Montesanti

  5. Department of Pediatrics, Division of Nephrology, University of Alabama at Birmingham, 1600 7th Ave South, ACC 516, Birmingham, AL, 35233, USA

    David J. Askenazi

Authors
  1. David J. Askenazi
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  2. Rajesh Koralkar
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  3. Hayden E. Hundley
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  4. Angela Montesanti
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  5. Neha Patil
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  6. Namasivayam Ambalavanan
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Corresponding author

Correspondence to David J. Askenazi.

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Askenazi, D.J., Koralkar, R., Hundley, H.E. et al. Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate. Pediatr Nephrol 28, 661–666 (2013). https://doi.org/10.1007/s00467-012-2369-4

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  • DOI: https://doi.org/10.1007/s00467-012-2369-4

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