Background AKI is witnessed in sick neonates and is associated with poor outcomes. Our cohort represents the profile of neonates who were diagnosed with AKI using KDIGO guidelines during intensive care unit stay. Methodology A cohort study was conducted in the NICU of FMH from June 2019 to May 2021. Data were collected on standardized proforma. Serum creatinine was measured within 24 hours after enrollment in the study by cytometric analysis using the C311 Rosch machine and subsequently after 24 to 48 hours.  Data analysis was done using SPSS v 20.0. All continuous variables were not normally distributed and were expressed as the median and interquartile range (IQR). Categorical variables were analyzed by proportional differences with either the Pearson chi-square test or Fisher’s exact tests. A multinomial logistic regression model was used to explore the independent risk factors of AKI. Time to the event (death) and survival curves for the cohort were plotted by using Cox proportional hazard model. Results AKI occurred in 473 (37.6%) of neonates and 15.7%, 16.3% and 5.6% had stage 1, 2 and 3 respectively. The outborn birth (p 0.000, AOR 3.987, 95%CI 2.564 – 6.200), birth asphyxia (p 0.000, AOR 3.567, 95%CI 2.093 – 6.080), inotropic agent (p 0.000, AOR 2.060, 95%CI 1.436 – 2.957), antenatal steroids (p 0.002, AOR 1.721, 95%CI 1.213 – 2.443), central lines (p 0.005, AOR 1.630, 95%CI 1.155 – 2.298), IVH/ICH/DIC (p 0.009, AOR1.580 , 95%CI 1.119 – 2.231) and NEC (p 0.054, AOR 1.747, 95%CI 0.990 – 3.083) were independently associated with AKI. Protective factors of neonatal AKI were normal sodium levels, maternal diabetes mellitus as well Hb>10.5 mg/dl. Duration of stay (7 vs 9 days) and mortality rates (3.9% vs16.5%) were significantly higher in neonates with AKI (p <0.001). Conclusion About one-third of critically sick neonates had AKI. Significant risk factors for AKI  were outborn birth (298%), birth asphyxia (256%), inotropic agents (106%) %, NEC 74.7%, antenatal steroids 72%, central lines 63% and IVH/ICH/DIC 58%.  AKI prolongs the duration of stay and reduces the survival of sick neonates.

Background and objectiveAcute kidney injury (AKI) was observed in sick neonates and was associated with poor outcomes. Our cohort represents the neonatal characteristics of those diagnosed with AKI using Kidney Disease: Improved Global Outcome (KDIGO) guidelines.MethodologyA cohort study was conducted in the NICU of FMH from June 2019 to May 2021. Data were collected on a proforma. All continuous variables were not normally distributed and expressed as the median and interquartile range. Categorical variables were analyzed by proportional differences with the Pearson chi-square test or Fisher's exact tests. A multinomial logistic regression model was used to explore the independent risk factors for AKI. Time to the event (death) and the cohort's survival curves were plotted using the Cox proportional hazard model.ResultsAKI occurred in 473 (37.6%) neonates. The risk factors of AKI were outborn birth [adjusted odds ratio (AOR): 3.987, 95% confidence interval (CI): 2.564–6.200, p: 0.000], birth asphyxia (AOR: 3.567, 95% CI: 2.093–6.080, p: 0.000), inotropic agent (AOR: 2.060, 95% CI: 1.436–2.957, p: 0.000), antenatal steroids (AOR: 1.721, 95% CI: 1.213–2.443, p: 0.002), central lines (AOR: 1.630, 95% CI: 1.155–2.298, p: 0.005) and intraventricular hemorrhage (IVH)/intracranial hemorrhage/disseminated intravascular coagulopathy (AOR: 1.580, 95% CI: 1.119–2.231, p: 0.009). AKI significantly increases the duration of stay and mortality rates by 16.5% vs. 3.9% in neonates with normal renal function (p &lt; 0.001).ConclusionAbout one-third of critically sick neonates had AKI. Significant risk factors for AKI were outborn birth, asphyxia inotropic agents, necrotizing enterocolitis, antenatal steroids central lines, and IVH. AKI is associated with an increased length of stay and increased mortality.

Objective: To identify the clinical presentations and outcomes of infant with Hemorrhagic Disease of Newborn (HDN). Study Design: Descriptive Cross-sectional study. Setting: Department of Neonatology, National Institute of Child Health (NICH), Karachi, Period: July to December 2021. Material & Methods: The babies diagnosed with HDN were included in the study. Age at onset of symptoms, gender, feeding pattern, place of delivery, site of bleeding and outcome were recorded. The outcome was compared with the chi-square test and the p-value <0.05 is considered significant. Results: Ninety five babies were included in the study. Male to female ratio was 1.87:1 and mean age of admission was 6.31 ± 5.98 days. The type of HDN was Early in 21 (22.1%), Classic in 55 (57.9%) and Late in 19 (20%) babies. In this study, 77.9 % babies were on exclusive breast feeding. Fifty four (56.8%) were delivered at homes, 9 (9.5%) at private clinics and 32 (33.7%) at government hospitals. In our country most babies are delivered at home where vitamin K is not given prophylactic to the newborn, leading to HDN. The site of bleeding were gastrointestinal, superficial, umbilicus and intracranial in 36 (37.9%), 24 (25.3 %), 21 (22.1%) and 12 (12.6%) neonates respectively. In this study, majority of babies (88.4 %) discharged. Conclusion: HDN was common in male gender, home deliveries, vaginal deliveries and breast fed.