Evaluation of neonatal acute kidney injury (AKI) after emergency gastrointestinal surgery

Cui, Yu; Fang, Xing; Li, Jia; Deng, Lingmei

doi:10.1016/j.asjsur.2022.08.086

Cited by 1 publication

(15 citation statements)

References 19 publications

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“…In the AWAKEN study AKI developed in 45% of extremely premature infants (<29 weeks GA) as compared to 14% of infants between 29 and 36 weeks GA (3). Studies specifically evaluating AKI post-abdominal surgery demonstrate similar associations of lower birth weight (<1500 grams), gestational age (under 32 weeks), and Apgar scores with increased risk of AKI (10).…”

Section: Preoperative Risk Factorsmentioning

confidence: 98%

“…This wide range of estimates is likely related to varying populations, pathologies, surgical procedures, and AKI definitions. The majority of studies utilize the 2017 modified neonatal Kidney Disease Improving Global Outcomes (KDIGO) creatine and urine output criteria to define AKI (Supplementary Table S1) (3,10). Postoperative AKI was an independent risk factor for mortality with up to a fourfold increase compared to infants who underwent surgery and did not develop AKI (11,28).…”

Section: Epidemiology Of Aki Post-abdominal Surgerymentioning

confidence: 99%

“…A total of 1,239 procedures and 1,141 intraabdominal procedures were performed (Table 1). The underlying pathology for surgery was categorized by etiology: (1) Peritonitis including NEC and gastrointestinal perforation; (2) Intestinal Obstruction due to intestinal atresia or stenosis, meconium ileus, and Hirschsprung's disease; (3) Abdominal Wall Anomalies and Compartment Syndrome including gastroschisis and omphalocele (Supplementary Table S2) (9)(10)(11)(12)29).…”

Section: Epidemiology Of Aki Post-abdominal Surgerymentioning

confidence: 99%

“…Infants requiring ventilatory support prior to abdominal surgery are at increased risk of postoperative AKI (10,41). A study of 329 Chinese infants at a single Children's hospital found that of the 44 infants were ventilated preoperatively, a quarter developed AKI postoperatively (n = 11).…”

Section: Respiratory Distress and Mechanical Ventilationmentioning

confidence: 99%

“…A study of 329 Chinese infants at a single Children's hospital found that of the 44 infants were ventilated preoperatively, a quarter developed AKI postoperatively (n = 11). Even after adjusting for other AKI risk factors, infants ventilated preoperatively displayed 3 times higher risk of AKI (aOR 3.47, 95% 1.05-11.46) (10). The association between mechanical ventilation and AKI development may be related to hypotension, decreased kidney perfusion, and potentiated inflammation (6,9).…”

Section: Respiratory Distress and Mechanical Ventilationmentioning

confidence: 99%

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Acute kidney injury post-abdominal surgery in infants: implications for prevention and management

et al. 2023

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Acute kidney injury (AKI) is common in critically ill infants and is associated with long-term sequelae including hypertension and chronic kidney disease. The etiology of AKI in infants is multifactorial. There is robust literature highlighting the risk of AKI after cardiothoracic surgery in infants. However, risk factors and outcomes for AKI in infants after abdominal surgery remains limited. This article reviews the epidemiology and association of abdominal surgery with postoperative AKI and suggests methods for AKI management and prevention. Postoperative AKI may result from hemodynamic shifts, hypoxia, exposure to nephrotoxic medications, and inflammation. Infants in the intensive care unit after intraabdominal surgeries have a unique set of risk factors that predispose them to AKI development. Prematurity, sepsis, prolonged operation time, emergent nature of the procedure, and diagnosis of necrotizing enterocolitis increase risk of AKI after intrabdominal surgeries. Prevention, early diagnosis, and management of AKI post-abdominal surgery is imperative to clinical practice. Close monitoring of urine output, serum creatinine, and fluid status is necessary in infants after abdominal surgery. A recent study suggests elevated levels of a urinary biomarker, neutrophil gelatinase-associated lipocalin (NGAL), 24 h after an abdominal procedure may improve early prediction of AKI. Identification of risk factors, avoidance of nephrotoxic medications, careful fluid balance, early detection of AKI, and maintenance of hemodynamic stability is imperative to potentially prevent and/or mitigate AKI.

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Section: Preoperative Risk Factorsmentioning

confidence: 98%