Acute Kidney Injury in the Neonatal Intensive Care Unit: Incidence and Risk Factors

Abstract

Introduction and Aim: Acute Kidney Injury (AKI) is a common medical problem, especially in neonatal intensive care unit. However, the reported incidences and associated risk factors are widely heterogenous and sometimes absent for developing countries. Thus, the current work designed to explore the incidence and potential risk factors of AKI for critically ill neonates.
 Patients and methods: The current work was an observational prospective study, completed between March 2019 and March 2022. It included 459 newborns admitted to the NICUs at Al-Azhar University Hospital (New Damietta) and Damietta General Hospital (Ministry of Health, Damietta, Egypt). For all neonates, careful history and clinical examination were done and data was documented. Then, repeated creatinine measurements and arterial blood gas analysis were performed. Discharge or death was the primary end point of the study. Other comorbid conditions were the secondary outcome.
 Results: The incidence of AKI was 92.2% and there was no significant difference between AKI and non-AKI regarding neonatal age, sex and mode of delivery. Patients with AKI had significantly lower gestational age, reduced birth weight, pH and HCO3. The serum creatinine showed significant increase during the first week of NICU admission in AKI than non-AKI groups, while basal values did not. Sepsis, nephrotoxic medications, hypoxic ischemic encephalopathy, umbilical catheter, duration of admission and mortality, all were significantly higher in AKI than non-AKI groups. Sepsis was reported among 44.8% and 27.7%, while mortality was reported for 20.9% and 4.9% of AKI and non-AKI groups, respectively. The duration of admission was 15.25±3.19 vs 9.50±2.21 days respectively.
 Conclusion: AKI was relatively higher (29.2% of admitted neonates) and associated with prematurity and lower birth weight. Neonatal sepsis and exposure to nephrotoxic drugs were among the commonest predisposing factors for AKI.

Incidence and predictors of acute kidney injury among asphyxiated neonates in comprehensive specialized hospitals, northwest Ethiopia, 2023

“…In contrast to the aforementioned studies, the present study was higher than studies conducted in Kenya at 11.7% 30 , Egypt at 29.2 31 Tanzania at 31.5% 32 India at 4.24% 33 , Ethiopia at 18.27% 34 , Macedonia 6.5 35 in Pakistan 37.6 36 , in India 25.70% 37 in turkey 8.4% 38 , It seems that the marked difference observed in the previous studies could be attributed to the criteria used to diagnose and include subjects in the studies. Specifically, these studies included all admitted neonates, particularly those who were critically ill When studying acute kidney injury (AKI) in neonates, the inclusion of a broader range of critically ill neonates may lead to differences in the observed incidence and characteristics of AKI compared to studies that focus on specific subgroups or exclude less severe cases.…”

“…Critically ill neonates may have multiple risk factors and comorbidities that can contribute to the development of AKI 32 , 37 , It seems that referring to a potential limitation in the studies conducted in a single center, which may impact the generalizability of the results studies are conducted in a single-center, the findings may be influenced by the specific characteristics and practices of that particular institution. Factors such as patient population, clinical protocols, and resources available at that center can vary and may not be representative of other healthcare settings 31 Additionally, multicenter studies can increase the sample size, potentially enhancing the statistical power and reliability of the results 35 , 38 .…”