A new approach to define acute kidney injury in term newborns with hypoxic ischemic encephalopathy

Abstract

Background

Current definitions of acute kidney injury (AKI) are not sufficiently sensitive to identify all newborns with AKI during the first week of life.

Methods

To determine whether the rate of decline of serum creatinine (SCr) during the first week of life can be used to identify newborns with AKI, we reviewed the medical records of 106 term neonates at risk of AKI who were treated with hypothermia for hypoxic ischemic encephalopathy (HIE).

Results

Of the newborns enrolled in the study, 69 % showed a normal rate of decline of SCr to ≥50 % and/or reached SCr levels of ≤0.6 mg/dl before the 7th day of life, and therefore had an excellent clinical outcome (control group). Thirteen newborns with HIE (12 %) developed AKI according to an established neonatal definition (AKI–KIDGO group), and an additional 20 newborns (19 %) showed a rate of decline of SCr of <33, <40, and <46 % from birth to days 3, 5, or 7 of life, respectively (delayed rise in estimated SCr clearance group). Compared to the control group, newborns in the other two groups required more days of mechanical ventilation and vasopressor drugs and had higher gentamicin levels, more fluid overload, lower urinary epidermal growth factor levels, and a prolonged length of stay.

Conclusions

The rate of decline of SCr provides a sensitive approach to identify term newborns with AKI during the first week of life.

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Acknowledgments

We thank Sofia Perazzo for assistance in data analysis and presentation and Glenn M. Chertow for helpful discussions. This study was supported by National Institutes of Health (NIH) awards R0-1 HL-102497, R01-DK 49419, and U54HD071601.

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Correspondence to Patricio E. Ray.

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The authors declare no conflict of interest.

Ethics statement

This Institutional Review Board at Children’s National Health System approved the study protocol in adherence to the Declaration of Helsinki and waived the need for consent.

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Supplemental Table S1

Serum Creatinine values in newborns with HIE during the first week of life (DOC 47 kb)

Supplemental Table S2

ROC curves for SCr and SCr decline combined. Samples from Controls and AKI-KDIGO + DReCrCl groups combined (n = 106) (DOC 12 kb)

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Gupta, C., Massaro, A.N. & Ray, P. A new approach to define acute kidney injury in term newborns with hypoxic ischemic encephalopathy. Pediatr Nephrol 31, 1167–1178 (2016). https://doi.org/10.1007/s00467-016-3317-5

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Keywords

  • Neonate
  • Acute kidney injury
  • Biomarkers
  • Serum creatinine
  • Epidermal growth factor