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

Abstract

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.

Discrepant changes of urinary cystatin C and other urinary biomarkers in preterm neonates

“…The incidence of AKI in critically ill preterm neonates is 40–70%. 22 Current definitions for AKI in these patients still have shortcomings. We need reference intervals for urinary biomarkers of AKI by post-conceptual age, to identify injury and target possible interventions.…”

Pediatric Acute Kidney Injury: Focusing on Diagnosis and Management

“…Despite its im portance, physicians often do not devote attention to the accumulation of risk factors and early dec line of kidney function as they perform or attend to other important aspects of care 33) . Recently, a system using elect ronic health records was implemented and helped physi cians detect AKI early and mitigate the influence of risk factors 34) .…”

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

“…Presence of shock, sepsis, use of mechanical ventilation and need of renal replacement therapy were associated with higher mortality in neonates with AKI [11][12][13][14][15] . Most neonatal caretakers are unaware about the current standard definition, risk factors associated with AKI and the risk of chronic kidney disease in preterm infants 16 . So, the current study was conducted to determine the aetiology and predictors of mortality in critically ill neonates with AKI.…”