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

Abstract

Background: In India, the incidence of acute kidney injury (AKI) ranges from 4.2% to 37.1%, with a 60% mortality in neonates.Objectives: To determine the aetiology and outcome of AKI in critically ill neonates. Method:A 1 year prospective observational study was undertaken at a tertiary institute on critically ill neonates who fulfilled the inclusion criteria. AKI was diagnosed based on a plasma creatinine level >1.5mg/dl and the plasma creatinine was repeated at 72 hours and on the 7th day of diagnosis. Aetiology and risks of mortality were analysed.Results: Male: female ratio was 1.55:1. Around 60% neonates were term and 64.6% had normal birth weight. Anaemia was the commonest maternal illness followed by hypertension. Sepsis was associated with 60% neonates with AKI followed by dehydration (19.2%) and birth asphyxia (14.6%). All neonates with proven sepsis and HIE stage III succumbed. Escherichia coli was the commonest isolate in the septic neonate. Mortality rate was 33.1%. Presence of maternal anaemia, hypertension, oliguria, high mean serum creatinine, acidosis and hyponatraemia were related to a higher mortality. Likewise, sepsis, shock, asphyxia, respiratory distress syndrome, use of mechanical ventilation and need of renal replacement therapy in neonates were significantly associated with a high mortality. Sepsis, birth asphyxia and use of mechanical ventilation were the independent risk factors of mortality.