Neonatal and Paediatric Heart and Renal Outcomes Network: design of a multi-centre retrospective cohort study

Abstract

Background:Cardiac surgery-associated acute kidney injury is common. In order to improve our understanding of acute kidney injury, we formed the multi-centre Neonatal and Pediatric Heart and Renal Outcomes Network. Our main goals are to describe neonatal kidney injury epidemiology, evaluate variability in diagnosis and management, identify risk factors, investigate the impact of fluid overload, and explore associations with outcomes.Methods:The Neonatal and Pediatric Heart and Renal Outcomes Network collaborative includes representatives from paediatric cardiac critical care, cardiology, nephrology, and cardiac surgery. The collaborative sites and infrastructure are part of the Pediatric Cardiac Critical Care Consortium. An acute kidney injury module was developed and merged into the existing infrastructure. A total of twenty-two participating centres provided data on 100–150 consecutive neonates who underwent cardiac surgery within the first 30 post-natal days. Additional acute kidney injury variables were abstracted by chart review and merged with the corresponding record in the quality improvement database. Exclusion criteria included >1 operation in the 7-day study period, pre-operative renal replacement therapy, pre-operative serum creatinine >1.5 mg/dl, and need for extracorporeal support in the operating room or within 24 hours after the index operation.Results:A total of 2240 neonatal patients were enrolled across 22 centres. The incidence of acute kidney injury was 54% (stage 1 = 31%, stage 2 = 13%, and stage 3 = 9%).Conclusions:Neonatal and Pediatric Heart and Renal Outcomes Network represents the largest multi-centre study of neonatal kidney injury. This new network will enhance our understanding of kidney injury and its complications.

Acute Kidney Injury After Neonatal Aortic Arch Surgery: Deep Hypothermic Circulatory Arrest Versus Moderate Hypothermia With Distal Aortic Perfusion

“…13,19 In publications with similar used criteria, overall incidence of AKI after neonatal open heart surgery ranged between 52% and 75% for all stages, and from 9% to 46% for the severe AKI stage 3. 14,20 –23…”

“…Despite improvements in CPB management, the incidence of postoperative kidney injury remains high. 14 The risk of AKI is greater in the neonatal period because of the ongoing nephrogenesis and glomerular development and is especially pronounced after aortic arch surgery.…”

Fluid Accumulation After Neonatal Congenital Cardiac Operation: Clinical Implications and Outcomes

“…Accordingly, the NEonatal and Pediatiic Heait Renal Outcomes Network (NEPHRON) was developed, in pait, to investigat the impact of FO on neonatal cardiac surgery clinical outcomes. [4] We used the NEPHRON data infrast111cture to desc1ibe FO epidemiology and its association with in-hospital mo1tality, duration of mechanical ventilation, and ICU and hospital LOS. We hypothesized that FO is common after neonatal cai• diac surge1y and that peak %FO and longer time to first negative daily fluid balance ai• e independently associated with worse clinical outcomes.…”

Transient and persistent acute kidney injury phenotypes following the Norwood operation: a retrospective study

“…Acute kidney injury is a well-known complication following paediatric cardiac surgery with rates ranging from 10 to 60% depending on the definition applied. [1][2][3][4][5][6][7] Irrespective of the definition, acute kidney injury has been consistently associated with increased morbidity and mortality across heterogeneous cohorts of children undergoing congenital cardiac surgery. 2,5,6,8,9 Studies among critically ill children and neonates and have not explored the trajectory and variations in acute kidney injury time course but have rather focused on peak injury, 1,2,5,6 with most episodes peaking within the first 24-48 postoperative hours.…”

“…2,5,6,8,9 Studies among critically ill children and neonates and have not explored the trajectory and variations in acute kidney injury time course but have rather focused on peak injury, 1,2,5,6 with most episodes peaking within the first 24-48 postoperative hours. 3 It is possible that the phenotype of transient acute kidney injury that develops early in the postoperative course and resolves quickly may be different from acute kidney injury that persists. A recent consensus statement suggests that the meaningful time period for which acute kidney injury diagnosis may be most associated with outcomes is after 48 hours.…”