Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate

Abstract

Background Acute kidney injury (AKI) is common and portends mortality in several neonatal cohorts. Fluid overload is independently associated with poor outcomes in children and adults but has not been extensively studied in neonates. Methods Between February 2010 and May 2011, we followed 58 neonates who met the following criteria: birth weight >2,000 g, gestational age ≥34 weeks, 5-min Apgar ≤7, and parental consent. Serum creatinine (SCr) was measured daily for first 4 days of life. AKI was defined as a rise in SCr of >0.3 mg/dl or persistent SCr above 1.5 mg/dl. Results AKI was present in 9/58 (15.6 %) neonates and was associated with higher birth weight, being male, lower 5-min Apgar scores, lower cord pH, delivery room intubation, and absence of maternal pre-eclampsia. Percent weight accumulation at day 3 of life was higher in those with AKI [median= 8.2, interquartile range (IQR)=4.4–21.6)] than without AKI (median= −4) (IQR=−6.5 to 0.0) (p<0.001). Infants with AKI had lower survival rates than those without AKI [7/9 (72 %) vs. 49/49 (100 %) (p<0.02)]. Conclusions AKI incidence in this neonatal population is similar to other neonatal cohorts. Near-term/term infants with AKI have a higher mortality rate and a net positive fluid balance over the first few days of life.

Neonatal Acute Kidney Injury

“…89 Limited data are available on fluid overload in neonates. Askenazi et al 63 showed that sick late preterm neonates with AKI had a higher median fluid overload at day of life 3 than those without AKI (+8.2% vs -4%, P , .001). As fluid overload is a potentially modifiable risk factor for mortality, research into its impact on neonatal outcomes is critical to provide information to clinicians about fluid provision and the timing of renal replacement therapy.…”

Associations of fluid overload with mortality and kidney recovery in patients with acute kidney injury: A systematic review and meta-analysis

“…A cohort study reported that 67% severe sepsis patients developed evidence of fluid overload in first day under EGDT, which was associated with high risk of mortality [7]. Furthermore, compared with non-AKI patients, ample recent data have reported that higher rate of fluid overload was found in AKI patients, and fluid overload is associated with increased mortality rate in AKI patients [8][9][10]. There are also several studies reporting the association between fluid overload and kidney recovery, but results are still controversial [11,12].…”

Early fluid overload is associated with acute kidney injury and PICU mortality in critically ill children

“…Tissue edema may directly participate in the progression of AKI [8,9,15,19,24]. The previous studies conducted in children and infants suggest that both AKI and FO were associated with increased mortality [3,28]. However, whether or not the association of FO with mortality is due to direct effects of FO itself or due to indirect associations between FO and other disease states, such as AKI, is unknown [9].…”