Acute Kidney Injury in Asphyxiated Newborns Treated with Therapeutic Hypothermia

Selewski, David T.; Jordan, Brian K.; Askenazi, David; Dechert, Ronald E.; Sarkar, S

doi:10.1016/j.jpeds.2012.10.002

Cited by 192 publications

(153 citation statements)

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“…The importance and prognostic significance of AKI in the neonatal period is becoming increasingly apparent (6,11,16,17). Using contemporary categorical SCr-based definitions, we report for the first time that AKI is associated with Values are mean ± seM.…”

Section: Discussionmentioning

confidence: 99%

“…This and similar definitions have gained acceptance as a way to define AKI in newborns (9,10). A similar definition was used to study AKI in neonates with perinatal asphyxia not receiving therapeutic hypothermia (6) and recently by our group in neonates treated with therapeutic hypothermia for perinatal asphyxia (11). To date, the correlation between AKI and severity of hypoxicischemic injury on brain magnetic resonance imaging (MRI) has not been evaluated in neonates treated with therapeutic hypothermia.…”

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confidence: 99%

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Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia

et al. 2013

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Background:We hypothesized that acute kidney injury (AKI) in asphyxiated neonates treated with therapeutic hypothermia would be associated with hypoxic-ischemic lesions on brain magnetic resonance imaging (MRI). Methods: Medical records of 88 cooled neonates who had had brain MRI were reviewed. All neonates had serum creatinine assessed before the start of cooling; at 24, 48, and 72 h through cooling; and then on day 5 or 7 of life. A neonatal modification of the Kidney Disease: Improving Global Outcomes guidelines was used to classify AKI. MRI images were evaluated by a neuroradiologist masked to outcomes. Outcome of interest was abnormal brain MRI at 7-10 d of life. results: AKI was found in 34 (39%) of 88 neonates, with 15, 7, and 12 fulfilling criteria for stages 1, 2, and 3, respectively. Brain MRI abnormalities related to hypoxia-ischemia were present in 50 (59%) newborns. Abnormal MRI was more frequent in infants from the AKI group (AKI: 25 of 34, 73% vs. no AKI: 25 of 54, 46%; P = 0.012; odds ratio (OR) = 3.2; 95% confidence interval (CI) = 1.3-8.2). Multivariate analysis identified AKI (OR = 2.9; 95% CI = 1.1-7.6) to be independently associated with the primary outcome. conclusion: AKI is independently associated with the presence of hypoxic-ischemic lesions on postcooling brain MRI.

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Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia

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“…Some have suggested that the SCr should rise to an absolute value of .0.5 mg/dL and meet the previous criteria to qualify as AKI. 1,12 …”

Section: Definition Of Neonatal Akimentioning

confidence: 99%

“…Perinatal risk factors associated with the development of AKI are outlined in Table 2 and include low Apgar scores, intubation, low cord pH, and asystole. [8][9][10]12,45,[47][48][49][50] …”

Section: Perinatal Exposures and Eventsmentioning

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Neonatal Acute Kidney Injury

et al. 2015

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In recent years, there have been significant advancements in our understanding of acute kidney injury (AKI) and its impact on outcomes across medicine. Research based on single-center cohorts suggests that neonatal AKI is very common and associated with poor outcomes. In this state-of-the-art review on neonatal AKI, we highlight the unique aspects of neonatal renal physiology, definition, risk factors, epidemiology, outcomes, evaluation, and management of AKI in neonates. The changes in renal function with gestational and chronologic age are described. We put forth and describe the neonatal modified Kidney Diseases: Improving Global Outcomes AKI criteria and provide the rationale for its use as the standardized definition of neonatal AKI. We discuss risk factors for neonatal AKI and suggest which patient populations may warrant closer surveillance, including neonates ,1500 g, infants who experience perinatal asphyxia, near term/ term infants with low Apgar scores, those treated with extracorporeal membrane oxygenation, and those requiring cardiac surgery. We provide recommendations for the evaluation and treatment of these patients, including medications and renal replacement therapies. We discuss the need for long-term follow-up of neonates with AKI to identify those children who will go on to develop chronic kidney disease. This review highlights the deficits in our understanding of neonatal AKI that require further investigation. In an effort to begin to address these needs, the Neonatal Kidney Collaborative was formed in 2014 with the goal of better understanding neonatal AKI, beginning to answer critical questions, and improving outcomes in these vulnerable populations.

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Frequency of Acute Kidney Injury and Association With Mortality Among Extremely Preterm Infants

et al. 2022

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ImportanceNeonatal acute kidney injury (AKI) is common and associated with morbidity and mortality. The temporal relationship between AKI and critical illness, as well as the frequency of AKI definition components (urine output and serum creatinine [sCr] concentration change), are unknown in extremely low-birth-weight (ELBW) (&lt;1000 g), extremely preterm (&lt;29 weeks’ completed gestational age [GA]) infants.ObjectiveTo measure the frequency of AKI from birth to death or discharge with attention to the definition components as well as the temporal relationship of AKI to critical illness and death.Design, Setting, and ParticipantsA single-center, multiyear, retrospective cohort study was conducted at an academic level IV neonatal intensive care unit between January 1, 2012, and January 1, 2020. Participants included inborn ELBW and infants at 22 to 28 weeks’ completed GA with confirmed congenital anomalies who survived 12 hours or more.ExposuresExtremely preterm birth and ELBW.Main Outcomes and MeasuresThe primary outcome was AKI frequency. The timing, severity, and criteria for AKI were measured. The temporal relationship between AKI, organ dysfunction, and outcomes were quantified using odds ratios (ORs), logistic regression, and Shapley Additive Explanations. Acute kidney injury recognition, imaging, pediatric nephrology consultation, and follow-up were determined.ResultsA total of 436 infants (52% male; 44% Black) met the inclusion criteria (median BW, 725 g; median GA, 25.7 wk). Acute kidney injury was common in the first week of life (44%), primarily based on the change in the sCr concentration criterion (88%), and negatively associated with GA (OR, 0.69; 95% CI, 0.60-0.78), but positively associated with antecedent critical illness (OR, 1.17; 95% CI, 1.12-1.23), severe intraventricular hemorrhage (OR, 1.86; 95% CI, 1.12-3.08), late-onset sepsis (OR, 1.03; 95% CI, 1.02-1.03), and mortality (OR, 2.77; 95% CI, 1.63-4.72). Acute kidney injury had negligible clinical contribution to death within the model (Shapley Additive Explanation, &lt;0.5% change to outcome) relative to antecedent patient-concentration organ dysfunction (6%-15% change). Among infants with severe AKI, recognition (32%), nephrology inpatient consultation (16%), and outpatient follow-up (9%) were not common.Conclusions and RelevanceIn this cohort study of ELBW infants, AKI was common in the first week of life, inversely associated with GA, and followed organ (primarily cardiovascular) dysfunction. Acute kidney injury considered as the primary pathway to mortality was rare, and amelioration of AKI to modify death was not well supported.

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Acute Kidney Injury in Asphyxiated Newborns Treated with Therapeutic Hypothermia

Cited by 192 publications

References 21 publications

Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia

Relationship between acute kidney injury and brain MRI findings in asphyxiated newborns after therapeutic hypothermia

Neonatal Acute Kidney Injury

Frequency of Acute Kidney Injury and Association With Mortality Among Extremely Preterm Infants

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