Acute Kidney Injury in Sick Neonate: Incidence and Outcome

Abstract

Introduction: Acute kidney injury (AKI) is an important clinical problem in sick neonate. In most patients, AKI accompanies with a predisposing factor such as sepsis, asphyxia and surgery. The aims of this study were to determine the incidence, associated contributing factors and short term outcome of AKI in hospitalized newborn infants. Materials and Methods: This prospective cohort study was done in Dhaka Shishu Hospital from March 2011 to September 2011. This study included 300 sick neonates admitted during the study period. AKI was defined when serum creatinine level >1.5 mg/dl and BUN was >20 mg/dl on two separate occasions at 24 hours apart. Oliguria was defined as urine output <1ml/kg/ hr. Medical records of those patients were reviewed and data were analyzed using SPSS software.Results: Fourteen babies (4.66%) out of 300 sick neonates had AKI, of whom 64.2% were male and 35.7% female. The term and preterm neonates were 71% and 29% respectively. While a normal birth weight was observed in 57% cases, 35% had low birth weight and 7.14% had very low birth weight. Sepsis was the most common (71%) association of AKI, followed by perinatal asphyxia (52%). All patients had more than one predisposing factors. Frequency of oliguric kidney injury was 57% and non-oliguric was 43%. Mortality among the hospitalized neonate with AKI was 21%.Conclusion: This study showed that in a tertiary care hospital AKI is not uncommon (4.66%) in neonatal care unit. It is associated with some preventable conditions such as sepsis, perinatal asphyxia and shock. Outcome is poor in sick neonates with AKI (21% mortality) in comparison to sick neonates without AKI (10.3%).

Risk factors for acute neonatal renal failure

“…8±202.4 µmol/l), Naveed (265.7±155.7 µmol/l) and Halder (246.4±110 µmol/l). 15,17,19,20,22 The average duration of hospitalization found in the study is lower than those found by Momtaz in 2011 (12.6±1.0 days), by Zulik in 2015 (10.2±3.2 days), and by Ghobrial in 2015 (24.6±13.3 days). 16,23,30 18 Nevertheless, it remains higher than the majority of mortality rates found in other studies.…”

“…The hospital prevalence of acute renal failure in newborns is poorly known because the majority of published studies are monocentric with variable sample sizes. [15][16][17][18][19][20][21][22] Data found in Middle Eastern countries like India and Pakistan indicate a prevalence that varies between 1.54% and 10.8%. In France, it is estimated between 3 and 10%, which is two times lower than that found in the Anglo-Saxon literature (United States) which is 8 to 24%.…”

“…3,[5][6][7]24 The male predominance found in the study is in agreement with that found in most of the published studies. 15,17,[19][20][21][22]25 The reason for this predominance can be explained by a greater susceptibility of boys to perinatal distress such as sepsis and respiratory distress. 15 The average gestational age found in the study is lower than that of the literature, which is 37 weeks.…”

Aetiology and mortality predictors in critically ill neonates with acute kidney injury at a tertiary health centre: a prospective observational study

“…In the present study, birth asphyxia was responsible for AKI in 14.6% neonates. It was 52.8% in a study by Halder S, et al 24 19 demonstrated that intrinsic AKI, need of mechanical ventilation and dialysis were associated with higher mortality. In our study, the presence of oliguria/acidosis/hyponatremia, high mean serum creatinine level, presence of sepsis/shock, neonates with birth asphyxia/ respiratory distress syndrome, use of mechanical ventilation and requirement of renal replacement therapy were associated with significantly higher mortality.…”

“…A multinational, multicentre, observation cohort study7 found that neonates with AKI had a higher mortality compared to those without AKI. Similarly, a higher mortality (21%) was observed by Halder S, et al24 in infants with AKI compared to 10% in infants without AKI.Bolat F, et al15 reported that the use of mechanical ventilation, requirement of peritoneal dialysis, presence of anuria, very low birth weight, bronchopulmonary dysplasia, use of inotropic support, high mean creatinine, high blood urea and low sodium level were the risk factors of mortality in neonates with AKI. In a study by Momtaz HE et al4 , higher mortality was noted in term neonates, female gender, birth weight >2500g, oliguric status and neonates who required dialysis while Pradha DD, et al…”