Acute Kidney Injury in Term Babies with Persistent Pulmonary Hypertension of the Newborn

Abstract

OBJECTIVE: The study aimed to determine the prevalence of acute kidney injury (AKI) in term neonates with persistent pulmonary hypertension of the newborn (PPHN), to identify the probable risk factors, and to find its relation to mortality.
 
 METHODS: The study recruited 758 term neonates admitted to the neonatal ICU (NICU). Diagnosis of PPHN was established on the basis of clinical and echocardiographic criteria. For diagnosis of AKI, we adopted the modified Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition. This definition has three grades of AKI severity depending on degree of serum creatinine rise and urinary output. Patients were followed until they died or discharged from NICU.
 
 RESULTS: Among the 758 term neonates included in the study, there were 47 babies (6.2 %) fulfilling the criteria of PPHN. AKI was reported in 16 patients (34.0 %) and the reported mortality rate was 31.9 %. Neonates with AKI had significantly higher mortality rate when compared with patients without AKI (75.0 % versus 9.7 %; p = 0.0001). A significant association was noted between severe grades of PPHN and AKI.
 
 CONCLUSIONS: AKI is prevalent in neonates with PPHN. It is significantly associated with mortality. There is suggested link between AKI and severity of PPHN.

Risk Factors and Outcomes of Acute Kidney Injury in Neonates with Persistent Pulmonary Hypertension of the Newborn

“…However, the overall incidence in our study agreed with previous studies. Sheta et al 12 evaluated 47 term infants with PPHN and reported an AKI rate of 34% by using modified KDIGO criteria. Kamolvisit et al 13 found an AKI rate of 28.4% among 109 PPHN infants.…”

“…Data in the literature on the association between PPHN severity and AKI are limited. Sheta et al 12 suggested a relationship between AKI and severe PPHN diagnosed by oxygenation index. In our study, severe PPHN diagnosed by echocardiography was associated with 5.7 foldincreased risk for AKI.…”

“…Most of the neonatal AKI studies have focused on infants with very low birth weight, asphyxia, and congenital heart disease. However, there are limited studies addressing AKI in patients with PPHN 12,13 .…”