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Introduction:Acute kidney injury (AKI) is one of the most common diseases among the newborns hospitalized in the neonatal intensive care units (NICUs), which is usually resulted from predisposing factors including sepsis, hypovolemia, asphyxia, respiratory distress syndrome (RDS), and heart failure. The goal of this study was to assess main etiologies, relevant risk factors, and early outcome of neonatal AKI.Materials and Methods:In a cross- sectional study, 49 consecutive neonates hospitalized in NICU of Besat hospital with diagnosis of AKI from October 2009 to October 2011 were investigated through census sampling method. AKI was diagnosed based on urine output and serum creatinine levels.Results:The prevalence of AKI was 1.54% (49 out of 3166 newborns hospitalized in NICU) with the female: male was 7:1. Thirty-nine patients (79.5%) were full-term neonates. Oliguria was observed in 38 (77.5%) patients. Sepsis was the most common predisposing factor for AKI in 77.5% of patients (n = 38) accompanied with the highest mortality rate among other factors (30.5%). Other leading causes of AKI included hypovolemia secondary to dehydration, followed by hypoxia secondary to RDS, patent ductus arteriosus, posterior urethral valve, asphyxia, and renal venous thrombosis. A positive relationship was observed between neonates' age, sex, urine output, and also between serum creatinine levels with initiation of dialysis. The mortality rate among the newborns hospitalized with AKI was 36.7%. Eighteen (36.7%) newborns were treated with peritoneal dialysis (PD) of whom 10 patients (55.6%) died, 31 patients were managed conservatively of whom five neonate died (25.9%).Discussion:Prognosis of AKI in the oliguric neonates requiring PD is very poor. It is thus recommended to prevent AKI by predicting and rapid diagnosis of AKI in patients with potential risk factors and also by early and effective treatment of such factors in individuals with AKI.

BackgroundProlonged empiric antibiotics therapy in neonates results in several adverse consequences including widespread antibiotic resistance, late onset sepsis (LOS), necrotizing enterocolitis (NEC), prolonged hospital course (HC) and increase in mortality rates.ObjectivesTo assess the risk factors and the outcome of prolonged empiric antibiotic therapy in very low birth weight (VLBW) newborns.Materials and MethodsProspective study in VLBW neonates admitted to NICU and survived > 2 W, from July 2011 - June 2012. All relevant perinatal and postnatal data including duration of antibiotics therapy (Group I < 2W vs Group II > 2W) and outcome up to the time of discharge or death were documented and compared.ResultsOut of 145 newborns included in the study, 62 were in group I, and 83 in Group II. Average duration of antibiotic therapy was 14 days (range 3 - 62 days); duration in Group I and Group II was 10 ± 2.3 vs 25.5 ± 10.5 days. Hospital stay was 22.3 ± 11.5 vs 44.3 ± 14.7 days, respectively. Multiple regression analysis revealed following risk factors as significant for prolonged empiric antibiotic therapy: VLBW especially < 1000 g, (P < 0.001), maternal Illness (P = 0.003), chorioamnionitis (P = 0.048), multiple pregnancy (P = 0.03), non-invasive ventilation (P < 0.001) and mechanical ventilation (P < 0.001). Seventy (48.3%) infants developed LOS; 5 with NEC > stage II, 12 (8.3%) newborns died. Infant mortality alone and with LOS/NEC was higher in group II as compared to group I (P < 0.002 and < 0.001 respectively).ConclusionsProlonged empiric antibiotic therapy caused increasing rates of LOS, NEC, HC and infant mortality.

Background: Exchange transfusion is commonly used in newborns for immediate treatment of severe hyperbilirubinemia to prevent bilirubin encephalopathy and kernicterus. Objectives: This study aimed to determine etiology and complications in newborns who received exchange transfusion for severe hyperbilirubinemia over the last five years. Patients and Methods: A retrospective study was performed on 28 days old infants who received exchange transfusion due to severe hyperbilirubinemia for a period of five years (from October 1st, 2006 through September 30th, 2011) in two neonatal units at Besat and Fatemieh hospitals in Hamadan, Iran. All data about patients' demographic characteristics, causes of hyperbilirubinemia, frequency, and complications of exchange transfusion were collected from medical records and analyzed using SPSS Version 12.0). Results: Exchange transfusion was performed in 148 neonates. Eighteen patients (12.2%) received exchange transfusion twice and seventeen patients (11.4%) three times or more. Among 118 neonates 80 (54.9%) were female and the mean gestational age and birth weight were 37.2 ± 2.5 weeks and 2847 ± 699 grams, respectively. The mean maximum total serum bilirubin levels were 27. 7.6 ± 7.28 mg/dL. Hemolytic disease was found in 72 (48.6%) of newborns. The most common cause of hemolysis was ABO incompatibility in 54 (36.5%). The etiologic factors were unidentified in 61 (41.2%) neonates. Complications occurred in 57 (38.5%) neonates and the most common complications were thrombocytopenia in 26 (17.6%) and hypocalcaemia in 17 (11.5%) neonates. Mortality was found in one (0.7%) neonate. Conclusions: The etiology of exchange transfusion was unidentified in most cases; however, ABO incompatibility was the most prevalent cause of hyperbilirubinemia. Complications were common after exchange transfusion and should be considered carefully.