Acute Kidney Injury Defined by Fluid Corrected Creatinine in Neonates After the Norwood Procedure

SooHoo, Megan; Patel, Sonali S.; Jaggers, James; Faubel, Sarah; Gist, Katja M.

doi:10.1177/2150135118775413

Cited by 31 publications

(26 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Many earlier studies reported that longer CPB duration was a major risk factor for AKI, conferring up to 7 times greater odds if CPB duration was greater than 180 minutes (4,11). Contrarily, a lack of association between CPB duration and AKI has been found by several other groups (15,25,26). The association seen only in 1 of the 3 surgeries could be because of cross-clamp time, as CPB duration was only significant in the setting of longer cross clamp times.…”

Section: Discussionmentioning

confidence: 97%

“…The association between AKI and higher VIS in the early post-operative period is likely a marker of illness severity (26,28). Garcia et al evaluated a cohort of adolescents and found that VIS was a predictor of worse outcomes (composite of death, cardiopulmonary resuscitation, mechanical circulatory support, arrhythmias, infection, acute neurologic injury and stage 3 AKI), but they did not specifically evaluate the association between AKI and higher VIS (29).…”

Section: Discussionmentioning

confidence: 99%

“…This is particularly important in the neonatal patients, in which identification of AKI can be particularly challenging as described above. In addition, patients may also have significant fluid overload and without correcting creatinine for fluid balance, AKI may have also been missed (25,26). In an attempt to correct fluid overload, some patients had prophylactic PD catheters placed in the operating room, almost exclusively after surgery 1, and mainly for drainage purposes.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Risk Factors for Recurrent Acute Kidney Injury in Children Who Undergo Multiple Cardiac Surgeries: A Retrospective Analysis

Hasson

Brinton

Cowherd

et al. 2019

Pediatric Critical Care Medicine

Self Cite

View full text Add to dashboard Cite

Objective: Determine the risk factors for repeated episodes of acute kidney injury (AKI) in children who undergo multiple cardiac surgical procedures Design: Single center retrospective chart review Setting: Cardiac intensive care unit at a quaternary pediatric care center Patients: Birth to 18 years who underwent at least 2 cardiac surgical procedures with cardiopulmonary bypass. Interventions: None Measurements and Main Results: 180 patients underwent 2 cardiac surgical procedures and 89 underwent 3. AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) serum creatinine criteria. AKI incidence was 26% (n = 46) after surgery 1, 20% (n = 36) after surgery 2, and 24% (n = 21) after surgery 3, with most AKI occurring on post-operative days 1 and 2. The proportion of patients with severe AKI increased from surgery 1 to surgery 3. Patients with AKI had a significantly longer duration of ventilation and length of stay after each surgery. The odds of AKI after surgery 3 was 2.40 times greater if AKI was present after surgery 1 or 2 (95% CI: 1.26 to 4.56, p = 0.008) after adjusting for confounders. The time between surgeries was not significantly associated with AKI (p = 0.85). Conclusions: In a heterogeneous population of pediatric patients with congenital heart disease undergoing multiple cardiopulmonary bypass surgeries, odds of AKI after a third surgery was

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Risk Factors for Recurrent Acute Kidney Injury in Children Who Undergo Multiple Cardiac Surgeries: A Retrospective Analysis

Hasson

Brinton

Cowherd

et al. 2019

Pediatric Critical Care Medicine

Self Cite

View full text Add to dashboard Cite

show abstract

“…Depending on the priming volume of the bypass circuit used, a neonate's volume of distribution may be increased 8-40% through the use of CPB and thus the decrease in sCr may be dilutional. Moreover, post-operative fluid shifts and the need for intravascular volume repletion are common and might impact sCr measurement [40,41].…”

Section: Discussionmentioning

confidence: 99%

Patterns of Urinary Neutrophil Gelatinase-Associated Lipocalin and Acute Kidney Injury in Neonates Receiving Cardiopulmonary Bypass

et al. 2020

View full text Add to dashboard Cite

Elevated urinary neutrophil gelatinase-associated lipocalin (uNGAL) predicts acute kidney injury (AKI) in children following cardiopulmonary bypass (CPB) during cardiac surgery, but little is known about uNGAL’s predictive ability in neonates in this setting. We sought to determine the relationship between AKI and post-CPB uNGAL in neonates in the first 72 post-operative hours. Methods: Urine samples for uNGAL analysis were collected at preoperative baseline and serially post-operatively from 76 neonates undergoing CPB. Mixed-effects regression models and logistic models assessed associations between uNGAL and AKI (controlling for sex, gestational age, CPB time, surgical complexity, and age at surgery). Receiver-operator curves were applied to define optimal uNGAL cut-off values for AKI diagnosis. Results: Between 0 and 4 h post-operatively, uNGAL values did not differ between neonates with and without AKI. After 4 h until 16 h post-operatively, significant time-wise separation occurred between uNGAL values of neonates with AKI and those without AKI. Odds ratios at each time point significantly exceeded unity, peaking at 10 h post-operatively (3.48 (1.58, 8.71)). Between 4 and 16 h post-operatively, uNGAL discriminated AKI from no-AKI, with a sensitivity of 0.63 (0.49, 0.75) and a specificity of 0.68 (0.62, 0.74) at a cut-off value of 100 ng/mL. Conclusion: After 4 h until 16 h post-operatively, elevated uNGAL is associated with AKI in neonates receiving CPB during cardiac surgery; however, this relationship is more complex than in older children.

show abstract

“…28 Fluid overload is a ubiquitous clinical entity that has been associated with prolonged mechanical ventilation, length of stay, and mortality. [29][30][31][32][33][34][35][36] However, the timing, degree, and association with acute kidney injury and other risk factors are poorly understood. Certainly, acute kidney injury contributes to fluid overload but not all neonates with acute kidney injury have fluid overload and not all neonates with fluid overload have acute kidney injury or oligo-anuria.…”

Section: Fluid Overloadmentioning

confidence: 99%

Neonatal and Paediatric Heart and Renal Outcomes Network: design of a multi-centre retrospective cohort study

Gist

Blinder

Bailly³

et al. 2019

Cardiol Young

Self Cite

View full text Add to dashboard Cite

Background:Cardiac surgery-associated acute kidney injury is common. In order to improve our understanding of acute kidney injury, we formed the multi-centre Neonatal and Pediatric Heart and Renal Outcomes Network. Our main goals are to describe neonatal kidney injury epidemiology, evaluate variability in diagnosis and management, identify risk factors, investigate the impact of fluid overload, and explore associations with outcomes.Methods:The Neonatal and Pediatric Heart and Renal Outcomes Network collaborative includes representatives from paediatric cardiac critical care, cardiology, nephrology, and cardiac surgery. The collaborative sites and infrastructure are part of the Pediatric Cardiac Critical Care Consortium. An acute kidney injury module was developed and merged into the existing infrastructure. A total of twenty-two participating centres provided data on 100–150 consecutive neonates who underwent cardiac surgery within the first 30 post-natal days. Additional acute kidney injury variables were abstracted by chart review and merged with the corresponding record in the quality improvement database. Exclusion criteria included >1 operation in the 7-day study period, pre-operative renal replacement therapy, pre-operative serum creatinine >1.5 mg/dl, and need for extracorporeal support in the operating room or within 24 hours after the index operation.Results:A total of 2240 neonatal patients were enrolled across 22 centres. The incidence of acute kidney injury was 54% (stage 1 = 31%, stage 2 = 13%, and stage 3 = 9%).Conclusions:Neonatal and Pediatric Heart and Renal Outcomes Network represents the largest multi-centre study of neonatal kidney injury. This new network will enhance our understanding of kidney injury and its complications.

show abstract

Acute Kidney Injury Defined by Fluid Corrected Creatinine in Neonates After the Norwood Procedure

Abstract: Acute kidney injury is common after the Norwood procedure. Correcting creatinine for fluid balance revealed new cases of AKI. Use of an mBTS and higher VIS on POD 0 were associated with increased risk of AKI.

Cited by 31 publications

References 44 publications

Risk Factors for Recurrent Acute Kidney Injury in Children Who Undergo Multiple Cardiac Surgeries: A Retrospective Analysis

Risk Factors for Recurrent Acute Kidney Injury in Children Who Undergo Multiple Cardiac Surgeries: A Retrospective Analysis

Patterns of Urinary Neutrophil Gelatinase-Associated Lipocalin and Acute Kidney Injury in Neonates Receiving Cardiopulmonary Bypass

Neonatal and Paediatric Heart and Renal Outcomes Network: design of a multi-centre retrospective cohort study

Contact Info

Product

Resources

About