Abstract
Background
Acute kidney injury (AKI) is common and associated with poor outcomes in critically ill neonates. The objective of this study was to study the incidence, risk factors, and clinical outcomes of AKI in neonates receiving non-cardiac surgery.
Methods
We performed a single-center retrospective study between January 2017 and December 2018 of neonates who had received abdominal and thoracic surgical procedures. AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patient information, clinical data, and outcomes were collected and analyzed. Logistic regression was used to analyze risk factors of AKI and association between AKI and mortality.
Results
Fifty-four (33.8%) of 160 patients developed AKI after surgical procedures. Compared with neonates without AKI, neonates with AKI had higher mortality rate (18.5% VS 5.7%, p = 0.022), lower gestational age (30.5 weeks, interquartile range [IQR] 28–33.5, VS 34.5 weeks, IQR 33–37.5, p = 0.035), higher rates of very low birth weight (33.3% VS 17.0%, p = 0.019), longer duration of mechanical ventilation (0.5 days, IQR 0–1.5, VS 0 days, IQR 0–1, p = 0.043) and higher rates of sepsis (35.2% VS 19.8%, p = 0.034). Risk factors of AKI included gestational age under 32 weeks (OR 4.8, 95% CI 1.8–12.6; p = 0.001), sepsis (OR 4.3, 95% CI 1.7–11.3; p = 0.003), operation time longer than 120 min (OR 2.7, 95% CI 1.1–6.6; p = 0.024), and diagnosis of necrotizing enterocolitis (OR 3.5, 95% CI 1.3–9.1; p = 0.011). AKI after surgery was significantly associated with mortality (OR 4.3, 95% CI 1.1–16.9; p = 0.036).
Conclusions
AKI is common and associated with poor outcomes in surgical neonates. Early recognition and intervention of AKI in these patients are important.
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References
Shalaby MA, Sawan ZA, Nawawi E, Alsaedi S, Al-Wassia H, Kari JA (2018) Incidence, risk factors, and outcome of neonatal acute kidney injury: a prospective cohort study. Pediatr Nephrol 33:1617–1624
Jetton JG, Boohaker LJ, Sethi SK, Wazir S, Rohatgi S, Soranno DE, Chishti AS, Woroniecki R, Mammen C, Swanson JR, Sridhar S, Wong CS, Kupferman JC, Griffin RL, Askenazi DJ, Neonatal Kidney Collaborative (NKC) (2017) Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health 1:184–194
Weintraub AS, Connors J, Carey A, Blanco V, Green RS (2016) The spectrum of onset of acute kidney injury in premature infants less than 30 weeks gestation. J Perinatal 36:474–480
Stojanović V, Barišić N, Milanović B, Doronjski A (2014) Acute kidney injury in preterm infants admitted to a neonatal intensive care unit. Pediatr Nephrol 29:2213–2220
Blinder JJ, Goldstein SL, Lee VV, Baycroft A, Fraser CD, Nelson D, Jefferies JL (2012) Congenital heart surgery in infants: effects of acute kidney injury on outcomes. J Thorac Cardiovasc Surg 143:368–374
Criss CN, Selewski DT, Sunkara B, Gish JS, Hsieh L, McLeod JS, Robertson JO, Matusko N, Gadepalli SK (2018) Acute kidney injury in necrotizing enterocolitis predicts mortality. Pediatr Nephrol 33:503–510
Kirkley MJ, Boohaker L, Griffin R, Soranno DE, Gien J, Askenazi D, Gist KM, Neonatal Kidney Collaborative (NKC) (2019) Acute kidney injury in neonatal encephalopathy: an evaluation of the AWAKEN database. Pediatr Nephrol 34:169–176
Selewski DT, Charlton JR, Jetton JG, Guillet R, Mhanna MJ, Askenazi DJ, Kent AL (2015) Neonatal acute kidney injury. Pediatrics 136:e463–e473
Bruel A, Roze JC, Flamant C, Simeoni U, Roussey-Kesler G, Allain-Launay E (2013) Critical serum creatinine values in very preterm newborns. PLoS One 8:e84892
Cuzzolin L, Fanos V, Pinna B, Di MM, Perin M, Tramontozzi P, Tonetto P, Cataldi L (2006) Postnatal renal function in preterm newborns: a role of diseases, drugs and therapeutic interventions. Pediatr Nephrol 21:931–938
Goldstein B, Giroir B, Randolph A, International Consensus Conference on Pediatric Sepsis (2005) International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 6:2–8
Selewski DT, Cornell TT, Heung M, Troost JP, Ehrmann BJ, Lombel RM, Blatt NB, Luckritz K, Hieber S, Gajarski R, Kershaw DB, Shanley TP, Gipson DS (2014) Validation of the KDIGO acute kidney injury criteria in a pediatric critical care population. Intensive Care Med 40:1481–1488
Mah KE, Hao S, Sutherland SM, Kwiatkowski DM, Axelrod DM, Almond CS, Krawczeski CD, Shin AY (2018) Fluid overload independent of acute kidney injury predicts poor outcomes in neonates following congenital heart surgery. Pediatr Nephrol 33:511–520
SooHoo M, Griffin B, Jovanovich A, Soranno DE, Mack E, Patel SS, Faubel S, Gist KM (2018) Acute kidney injury is associated with subsequent infection in neonates after the Norwood procedure: a retrospective chart review. Pediatr Nephrol 33:1235–1242
Park SK, Hur M, Kim E, Kim WH, Park JB, Kim Y, Yang JH, Jun TG, Kim CS (2016) Risk factors for acute kidney injury after congenital cardiac surgery in infants and children: a retrospective observational study. PLoS One 11:e0166328
Fitzgerald JC, Ross ME, Thomas NJ, Weiss SL, Balamuth F, Anderson AH (2018) Risk factors and inpatient outcomes associated with acute kidney injury at pediatric severe sepsis presentation. Pediatr Nephrol 33:1781–1790
Akcan Arikan A, Williams EA, Graf JM, Kennedy CE, Patel B, Cruz AT (2015) Resuscitation bundle in pediatric shock decreases acute kidney injury and improves outcomes. J Pediatr 167:1301–1305.e1
Fitzgerald JC, Basu RK, Akcan-Arikan A, Izquierdo LM, Piñeres Olave BE, Hassinger AB, Szczepanska M, Deep A, Williams D, Sapru A, Roy JA, Nadkarni VM, Thomas NJ, Weiss SL, Furth S, Sepsis Prevalence, Outcomes, and Therapies Study Investigators and Pediatric Acute Lung Injury and Sepsis Investigators Network (2016) Acute kidney injury in pediatric severe sepsis: an independent risk factor for death and new disability. Crit Care Med 44:2241–2250
Blatt NB, Srinivasan S, Mottes T, Shanley MM, Shanley TP (2014) Biology of sepsis: its relevance to pediatric nephrology. Pediatr Nephrol 29:2273–2287
Garg PM, Tatum R, Ravisankar S, Shekhawat PS, Chen YH (2015) Necrotizing enterocolitis in a mouse model leads to widespread renal inflammation, acute kidney injury, and disruption of renal tight junction proteins. Pediatr Res 78:527–532
Mammen C, Al Abbas A, Skippen P, Nadel H, Levine D, Collet JP, Matsell DG (2012) Long-term risk of CKD in children surviving episodes of acute kidney injury in the intensive care unit: a prospective cohort study. Am J Kidney Dis 59:523–530
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The ethics committee of West China Hospital of Sichuan University approved the study and informed parental consent was obtained.
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Wu, Y., Hua, X., Yang, G. et al. Incidence, risk factors, and outcomes of acute kidney injury in neonates after surgical procedures. Pediatr Nephrol 35, 1341–1346 (2020). https://doi.org/10.1007/s00467-020-04532-4
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DOI: https://doi.org/10.1007/s00467-020-04532-4