Neonatal Acute Kidney Injury: A Survey of Neonatologists' and Nephrologists' Perceptions and Practice Management

Kent, Alison; Charlton, Jennifer R.; Guillet, Ronnie; Gist, Katja M.; Hanna, Mina; Samra, Ahmad; Fletcher, Jeffery; Selewski, David T.; Mammen, Cherry

doi:10.1055/s-0037-1604260

Cited by 24 publications

(4 citation statements)

References 48 publications

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“…More than half used serum creatinine or urine output as the lone criteria. In a similar survey by Kent et al, nearly half of the neonatologists were unaware of the staged definitions of neonatal AKI (13). This study shows that there remains a gap in understanding regarding neonatal AKI and efforts at education are justified in the country.…”

Section: Discussionmentioning

confidence: 58%

Neonatal Acute Kidney Injury: A Survey of Perceptions and Management Strategies Amongst Pediatricians and Neonatologists

et al. 2020

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Background: Neonatal Acute Kidney Injury (AKI) occurs in 40-70% of critically ill newborn infants and is independently associated with increased morbidity and mortality. Understanding the practice patterns of physicians (neonatologists and pediatricians), caring for neonates in India is important to optimize care and outcomes in neonatal AKI. Aim:The aim of this study was to identify differences in physician's perception and practice variations of diagnosis, management, and follow-up of newborn infants with AKI in India.Methods: An online survey of neonatologists and pediatricians in India caring for newborn infants with AKI.Results: Out of 800 correspondents, 257 (135 neonatologists and 122 pediatricians) completed the survey, response rate being 32.1%. Resources available to the respondents included level III NICU (59%), neonatal surgery (60%), dialysis (11%), and extracorporeal membrane oxygenation (ECMO, 3%). Most respondents underestimated the risk of AKI due to various risk factors such as prematurity, asphyxia, sepsis, cardiac surgery, and medications. Less than half the respondents were aware of the AKIN or KDIGO criteria, which are the current standard criteria for defining neonatal AKI. Only half of the respondents were aware of the risk of CKD in preterm neonates and nearly half were unaware of the need to follow up with a pediatric nephrologist.Conclusions: Similar to other regions worldwide, there exists a knowledge gap in early recognition, optimal management and follow up of newborn infants with AKI amongst Indian physicians.

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Section: Discussionmentioning

confidence: 58%

Neonatal Acute Kidney Injury: A Survey of Perceptions and Management Strategies Amongst Pediatricians and Neonatologists

et al. 2020

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“…Over the years, PD has become an effective and increasingly popular alternative to HD in the management of critically ill neonates, including premature infants [ 9 , 28 ]. PD has been relatively safe, technically simple, and cost-effective.…”

Section: Discussionmentioning

confidence: 99%

“…The treatment of the metabolic complications of AKI includes appropriate management of fluids, electrolytes, and acid-base balance and appropriate nutrition [ 8 , 9 ]. Despite the non-dialytic management of AKI among newborns, the major indications for initiating renal replacement therapy (RRT) include severe oliguria despite fluid therapy, diuretic administration, and inotropic support; refractory electrolyte imbalance; and worsening uremia [ 8 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Challenges of acute peritoneal dialysis in extremely-low-birth-weight infants: a retrospective cohort study

et al. 2020

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Background Peritoneal dialysis (PD) has been used occasionally in extremely-low-birth-weight (ELBW) infants with acute kidney injury (AKI). This study aimed to evaluate the clinical characteristics and outcomes of ELBW infants with AKI treated with PD. Methods In this retrospective cohort study, the medical records of ELBW infants with AKI, who underwent PD from January 2008 to February 2018, were reviewed. A PD catheter (7.5–9.0 Fr) or central venous catheter (4 Fr) was used for the peritoneal access. Treatment with PD solutions (2.5 or 4.25%) was started at 10 mL/kg, which was increased to 20–30 mL/kg for 60–120 min/cycle continuing for 24 h. Results Twelve ELBW infants (seven male and five female infants) were treated, and their mean (±SD) gestational age and birth weight were 27.2 (±3.3) weeks and 706.5 (±220.5) g, respectively. Two patients had severe perinatal asphyxia (5-min Apgar score ≤ 3). The most important indication for starting PD was AKI due to sepsis. The average (±SD) duration of PD was 9.4 (± 7.7) days. The potassium levels in the ELBW infants with hyperkalemia decreased from 6.8 to 5.0 mg/mL after 9.3 (± 4.4) days. The most common complication of PD was mechanical dysfunction of the catheters, such as dialysate leakage (75%). Two patients were successful weaned off PD. The mortality rate of the infants treated with PD was 91.7%. Conclusions In this series, the mortality rate of ELBW infants with AKI treated with PD was relatively high because of their incompletely developed organ systems. Therefore, the use of PD should be carefully considered for the treatment of ELBW infants with AKI in terms of decisions regarding resuscitation.

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“…An international survey of neonatologists and paediatric nephrologists evaluated the practice patterns and perceptions surrounding neonatal acute kidney injury and demonstrated significant practice variation in the long-term renal follow-up after an episode of acute kidney injury in neonates admitted to the neonatal intensive care unit. 13 There is a need for kidney function follow-up guidelines in neonates undergoing cardiac surgery, with a goal to implement measures (i.e., avoid nephrotoxins, treat hypertension and proteinuria) to reduce chronic kidney disease incidence and progression. As a first step towards this goal, there is a need to understand the current practice of follow-up and the factors associated with the presence of follow-up.…”

Section: Introductionmentioning

confidence: 99%

Paucity of renal follow-up by school age after neonatal cardiac surgery

et al. 2020

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Introduction:There are little data about renal follow-up of neonates after cardiovascular surgery and no guidelines for long-term renal follow-up. Our objectives were to assess renal function follow-up practice after neonatal cardiac surgery, evaluate factors that predict follow-up serum creatinine measurements including acute kidney injury following surgery, and evaluate the estimated glomerular filtration rate during follow-up using routinely collected laboratory values.Methods:Two-centre retrospective cohort study of children 5–7 years of age with a history of neonatal cardiac surgery. Univariable and multivariable analyses were performed to determine factors associated with post-discharge creatinine measurements. Glomerular filtration rate was estimated for each creatinine using a height-independent equation.Results:Seventeen of 55 children (30%) did not have any creatinine measured following discharge after surgery until the end of study follow-up, which occurred at a median time of 6 years after discharge. Of the 38 children who had the kidney function checked, 15 (40%) had all of their creatinine drawn only in the context of a hospitalisation or emergency department visit. Acute kidney injury following surgery did not predict the presence of follow-up creatinine measurements.Conclusions:A large proportion of neonates undergoing congenital heart repair did not have a follow-up creatinine measured in the first years following surgery. In those that did have a creatinine measured, there did not appear to be any identified pattern of follow-up. A follow-up system for children who are discharged from cardiac surgery is needed to identify children with or at risk of chronic kidney disease.

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Neonatal Acute Kidney Injury: A Survey of Neonatologists' and Nephrologists' Perceptions and Practice Management

Abstract: Neonatal AKI is underappreciated, particularly among neonatologists. A lack of evidence on neonatal AKI contributes to this variation in response. Therefore, dissemination of current knowledge and areas for research should be the priority.

Cited by 24 publications

References 48 publications

Neonatal Acute Kidney Injury: A Survey of Perceptions and Management Strategies Amongst Pediatricians and Neonatologists

Neonatal Acute Kidney Injury: A Survey of Perceptions and Management Strategies Amongst Pediatricians and Neonatologists

Challenges of acute peritoneal dialysis in extremely-low-birth-weight infants: a retrospective cohort study

Paucity of renal follow-up by school age after neonatal cardiac surgery

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