Abstract
Background
High-frequency ventilation (HFV) is frequently used in critically ill preterm neonates. We aimed to determine the incidence of acute kidney injury (AKI) in neonates less than 29 weeks gestation who received HFV in the first week of life and to determine if the rates of AKI differed in those who received other forms of respiratory support.
Methods
This retrospective cohort study of 24 international, level III/IV neonatal intensive care units (NICUs) included neonates less than 29 weeks gestation from the AWAKEN study database. Exclusion criteria included the following: no intravenous fluids ≥ 48 h, admission ≥ 14 days of life, congenital heart disease requiring surgical repair at < 7 days of life, lethal chromosomal anomaly, death within 48 h, severe congenital kidney abnormalities, inability to determine AKI status, insufficient data on ventilation, and when the diagnosis of early AKI was unable to be made. Subjects were grouped into three groups based on ventilation modes (CPAP/no ventilation, conventional ventilation, and HFV).
Results
The incidence of AKI was highest in the CPAP/no ventilation group, followed by HFV, followed by conventional ventilation (CPAP/no ventilation 48.5% vs. HFV 42.6% vs. conventional ventilation 28.4% (p = 0.009). An increased risk for AKI was found for those on HFV compared to CPAP/no ventilation (HR = 2.65; 95% CI:1.22–5.73).
Conclusions
HFV is associated with AKI in the first week of life. Neonates on HFV should be screened for AKI. The reasons for this association are not clear. Further studies should evaluate the relationship between ventilator strategies and AKI in premature neonates.
Graphical abstract
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Data Availability
The data from this study is maintained by the Neonatal Kidney Collaborative.
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Acknowledgements
We acknowledge the outstanding work of the following clinical research personnel and colleagues for their involvement in the AWAKEN study:
(1) Ariana Aimani, Samantha Kronish, Ana Palijan, MD, Michael Pizzi (Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada)
(2) Laila Ajour, BS, Julia Wrona, BS (University of Colorado, Children’s Hospital Colorado, Aurora)
(3) Melissa Bowman, RN (University of Rochester, Rochester, New York)
(4) Teresa Cano, RN, Marta G. Galarza, MD, Wendy Glaberson, MD, Aura Arenas Morales, MD, Denisse Cristina Pareja Valarezo, MD (Holtz Children’s Hospital, University of Miami, Miami, Florida)
(5) Sarah Cashman, BS, Madeleine Stead, BS (University of Iowa Children’s Hospital, Iowa City)
(6) Jonathan Davis, MD, Julie Nicoletta, MD (Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, Massachusetts)
(7) Alanna DeMello (British Columbia Children’s Hospital, Vancouver, Canada)
(8) Lynn Dill, RN, Emma Perez-Costas, PhD (The University of Alabama at Birmingham)
(9) Ellen Guthrie, RN (MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio)
(10) Nicholas L. Harris, BS, Susan M. Hieber, MSQM (C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor)
(11) Katherine Huang, Rosa Waters (University of Virginia Children’s Hospital, Charlottesville)
(12) Judd Jacobs, Ryan Knox, BS, Hilary Pitner, MS, Tara Terrell (Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio)
(13) Nilima Jawale, MD (Maimonides Medical Center, Brooklyn, New York)
(14) Emily Kane (Australian National University, Canberra, Australia)
(15) Vijay Kher, DM, Puneet Sodhi, MBBS (Medanta Kidney Institute, Medanta the Medicity, Gurgaon, Haryana, India)
(16) Grace Mele (New York College of Osteopathic Medicine, Westbury)
(17) Patricia Mele, DNP (Stony Brook Children’s Hospital, Stony Brook, New York)f
(18) Charity Njoku, Tennille Paulsen, Sadia Zubair (Texas Children’s Hospital, Baylor College of Medicine, Houston)
(19) Emily Pao (University of Washington, Seattle Children’s Hospital, Seattle)
(20) Becky Selman, RN, Michele Spear, CCRC (University of New Mexico Health Sciences Center, Albuquerque)
(21) Melissa Vega, PA-C (The Children’s Hospital at Montefiore, Bronx, New York)
(22) Leslie Walther, RN (Washington University in St Louis, Missouri)
Neonatal Kidney Collaborative (NKC) collaborators
The following individuals served as collaborators and site investigators for the AWAKEN study. They collaborated in protocol development and review, submission to local institutional review boards, and data collection and participated in drafting or review of the manuscript.
David T Selewski, Subrata Sarkar (DS: Medical University of South Carolina; SS: Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA)
Jeffery Fletcher, Alison Kent (Centenary Hospital for Women and Children, Canberra Hospital, Australian National University Medical School, Canberra, ACT, Australia; AK: University of Rochester)
Carolyn L Abitbol, Marissa DeFreitas, Shahnaz Duara (Holtz Children’s Hospital, University of Miami, Miami, FL, USA)
Jennifer R Charlton, Jonathan R Swanson (University of Virginia Children’s Hospital, Charlottesville, VA, USA)
Ronnie Guillet, Carl D’Angio, Ayesa Mian, Erin Rademacher (Golisano Children’s Hospital, University of Rochester, Rochester, NY, USA)
Maroun J Mhanna, Rupesh Raina, Deepak Kumar (MM: Ochsner/Louisiana State University Health, Shreveport, LA; RR, DK: MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH, USA)
Namasivayam Ambalavanan (Children’s of Alabama, University of Alabama at Birmingham, Birmingham, AL, USA)
Ayse Akcan Arikan, Christopher J Rhee (Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, USA)
Stuart L Goldstein, Amy T Nathan (Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA)
Juan C Kupferman, Alok Bhutada, Shantanu Rastogi (Maimonides Medical Center, Brooklyn, NY, USA)
Elizabeth Bonachea, Susan Ingraham, John Mahan, Arwa Nada (EB, JM: Nationwide Children’s Hospital, Columbus, OH, USA; SI: Kapiolani Medical Center for Women & Children; AN: LeBoneur’s Children’s Hospital/University of Tennessee, Memphis, TN)
Patrick D Brophy, Tarah T Colaizy, Jonathan M Klein (PDB: University of Rochester; TTC, JMK: University of Iowa Children’s Hospital, Iowa City, IA, USA)
F Sessions Cole, T Keefe Davis (FSC: Washington University, St Louis, MO, USA; TKD: University of Saskatchewan)
Joshua Dower, Lawrence Milner, Alexandra Smith (Tufts University School of Medicine, Boston, MA, USA)
Mamta Fuloria, Kimberly Reidy, Frederick J Kaskel (The Children’s Hospital at Montefiore, Bronx, NY,USA)
Danielle E Soranno, Jason Gien, Katja M Gist (DS: Indiana University; JG: University of Colorado, Children’s Hospital Colorado, Aurora, CO, USA; KG: Cincinnati Children’s Hospital)
Aftab S Chishti, Mina H Hanna (University of Kentucky, Lexington, KY, USA)
Sangeeta Hingorani, Sandra Juul, Michelle Starr (SH, SJ: University of Washington, Seattle Children’s Hospital, Seattle, WA, USA; MS: Indiana University)
Craig S Wong, Catherine Joseph, Tara DuPont, Robin Ohls, Amy Staples (CSW, CJ, TD, AS: University of New Mexico Health Sciences Center, Albuquerque, NM, USA; RO: University of Utah)
Smriti Rohatgi, Sidharth K Sethi (Kidney and Urology Institute Medanta—The Medicity, Gurgaon, India)
Sanjay Wazir (Neonatology, Cloudnine Hospital, Gurgaon, Haryana, India)
Surender Khokhar (Apollo Cradle, Gurgaon, Haryana, India)
Sofia Perazzo, Patricio E Ray, Mary Revenis (SP, MR: Children’s National Medical Center, George Washington University School of Medicine and the Health Sciences, Washington, DC, USA; PR: University of Virginia)
Cherry Mammen, Anne Synnes (British Columbia Children’s Hospital, Vancouver, BC, Canada)
Pia Wintermark, Michael Zappitelli (PW: Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada; MZ: SickKids)
Robert Woroniecki, Shanthy Sridhar (Stony Brook School of Medicine, Stony Brook, NY, USA)
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All authors declare no real conflicts of interest that could affect the study design, collection, analysis and interpretation of data, writing of the report, or the decision to submit for publication. For full disclosure, we provide here an additional list of authors’ commitments and funding sources that are not directly related to this study:
David J. Askenazi is a consultant for Baxter, Nuwellis, Bioporto, and Seastar. His institution has received grant funding for education and research that is not related to this project from NIH, Baxter, Nuwellis, Medtronic, Bioporto, Portero Leadiant Health, and Seastar. He has patents pending on inventions to improve the kidney care of neonates. He is the Founder and Chief Scientific Officer for Zorro-Flow Inc.
Funding for AWAKEN:
(1) Cincinnati Children’s Hospital Center for Acute Care Nephrology provided funding to create and maintain the AWAKEN Medidata Rave electronic database.
(2)The Pediatric and Infant Center for Acute Nephrology (PICAN) provided support for web meetings, for the NKC steering committee annual meeting at the University of Alabama at Birmingham (UAB), and support for some of the AWAKEN investigators at UAB (LBJ, RLG). PICAN is part of the Department of Pediatrics at the UAB, and is funded by the Department of Pediatrics at Children’s of Alabama, UAB School of Medicine, and UAB’s Center for Clinical and Translational Sciences (NIH grant UL1TR001417).
(3)The AWAKEN study at the University of New Mexico was supported by the Clinical and Translational Science Center (NIH grant UL1TR001449) and by the University of Iowa Institute for Clinical and Translational Science (U54TR001356).
(4)AWAKEN investigators at the Canberra Hospital were supported by the Canberra Hospital Private Practice fund.
(5)Investigators at University of Virginia Children’s Hospital were supported by a 100 Women Who Care Grant.
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Haynes, N., Bell, J., Griffin, R. et al. Receipt of high-frequency ventilation is associated with acute kidney injury in very preterm neonates. Pediatr Nephrol 39, 579–587 (2024). https://doi.org/10.1007/s00467-023-06077-8
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DOI: https://doi.org/10.1007/s00467-023-06077-8