Original Research ArticleClinical profile and outcome of acute kidney injury in neonatal sepsis in a tertiary care centre Divya Durga*, Sudha Rudrappa INTRODUCTIONNeonatal sepsis is one of the major global health problems. Thirty eight percent of all childhood deaths occur in neonates 1 . Ninety nine percent of these neonatal deaths occur in low-income and middle-income countries.1 In developing countries like India, sepsis contributes to 37% of all neonatal deaths.2 As per the National Neonatal Perinatal Database (NNPD) 2002 -2003, the incidence of neonatal sepsis is 30 per 1000 live births3. Sepsis affects many important organs of the body leading to multiple organ dysfunction syndrome (MODS) of which kidney is one of the most important organs to be affected.Acute renal failure (ARF) is characterized by sudden (within 48 hours) impairment in kidney function that results in the retention of nitrogenous waste products, e.g. ABSTRACTBackground: Septicemia remains a leading cause of morbidity and mortality among neonates with AKI complicating as many as 3.4 to 24% of them. The actual incidence of renal failure in all sepsis cases is not documented. There are several studies in the literature on renal failure in neonates which were based on older definitions using blood urea and urine output as parameters. The major limitation of the older studies was that they did not use the current acute kidney injury network (AKIN) definition. In the present study, we have attempted to investigate AKI in neonatal sepsis using the AKIN definition based on serum creatinine (Table1). We also attempted to determine the predictors of AKI in neonatal sepsis. Methods: The present study was an explorative study conducted in the neonatal unit of Cheluvamba hospital attached to Mysore Medical College and Research Institute in which a total of 50 neonates with clinical/ culture positive sepsis were enrolled during the period of June 2014 to June 2015. Results: These neonates were investigated for the presence of AKI based on serum creatinine values of three consecutive days and were divided into two groups. Group 1 consisted of septic neonates with AKI and group 2 consisted of septic neonates without AKI. Both the groups were followed up till discharge or death. The risk factors associated with sepsis were compared in both the groups and predictors of morbidity and mortality associated with AKI in sepsis were also determined. Conclusions: Incidence and mortality associated with AKI in sepsis was found to be 24% and 75% respectively. Factors like PROM, foul smelling liquor, > 3 unclean vaginal examinations during labour were significant risk factors for development of AKI in sepsis. Culture positivity, associated meningitis, DIC, shock and need for assisted ventilation were poor prognostic indicators and were significantly associated with mortality.

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