Nephrotoxic medications and associated acute kidney injury in hospitalized neonates

Mohamed, Tahagod; Abdi, Hibo H.; Magers, Jacqueline; Prusakov, Pavel; Slaughter, Jonathan L.

doi:10.1007/s40620-022-01264-6

Cited by 19 publications

(12 citation statements)

References 32 publications

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“…In our study, the prevalence of perioperative AKI is higher compared to the general prevalence of AKI in the PHIS database during the same study period. We previously found that neonatal AKI occurs in 1-3% of neonates admitted to a participating NICU when ICD codes are used to identify AKI in PHIS and those rates are lower than what was previously reported in the literature using serum creatinine AKI criteria [18][19][20].…”

Section: Discussionmentioning

confidence: 70%

Perioperative Neonatal Acute Kidney Injury Is Common: Risk Factors for Poor Outcomes

Mohamed,

Mpody,

Nafiu

2023

Am J Perinatol

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Objective Perioperative acute kidney injury (AKI) is associated with poor patient outcomes. The epidemiology of perioperative AKI is characterized in children and to a lesser extent in neonates with cardiac disease. We hypothesized that the prevalence of noncardiac perioperative AKI in neonates is higher than in older children. We also hypothesized that certain neonatal characteristics and comorbidities increase the risk of perioperative AKI and hospital mortality. We aimed to characterize the epidemiology and risk factors of perioperative AKI in neonates undergoing noncardiac surgeries and outline the associated mortality risk factors. Study Design We performed a retrospective study of neonates ≤28 days old who underwent inpatient noncardiac surgery in 46 U.S. children's hospitals participating in the Pediatric Hospital Information System between 2016 and 2021. AKI was evaluated throughout the surgical admission encounter. AKI was defined using the International Classification of Diseases (ICD) versions 9 and 10 codes. Comorbid risk factors are chronic and longstanding diagnoses and were selected using ICD-9 and ICD-10 diagnostic and procedure codes. Results Perioperative AKI occurred in 10% of neonates undergoing noncardiac surgeries. Comorbidities associated with high risk of perioperative AKI included metabolic, hematologic/immunologic, cardiovascular, and renal disorders. The relative risk of mortality in perioperative AKI was highest in infants with low birthweight (relative risk = 1.49, 1.14–1.94) and those with hematologic (1.46, 1.12–1.90), renal (1.24, 1.01–1.52), and respiratory comorbidities (1.35, 1.09–1.67). Conclusion Perioperative AKI is common in neonates undergoing noncardiac surgeries. Infants with high-risk comorbidity profiles for the development of perioperative AKI and mortality may benefit from close surveillance of their kidney function in the perioperative period. Although retrospective, the findings of our study could inform clinicians to tailor neonatal perioperative kidney care to improve short- and long-term outcomes. Key Points

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Section: Discussionmentioning

confidence: 70%

Perioperative Neonatal Acute Kidney Injury Is Common: Risk Factors for Poor Outcomes

Mohamed,

Mpody,

Nafiu

2023

Am J Perinatol

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“…AKI, which occurs in almost 50% of all preterm infants, may contribute to early cessation of nephrogenesis. 21 In addition, over 90% of all neonates aged under 28 weeks gestation are prescribed nephrotoxic agents, 22 and their impact on postnatal nephron development cannot be ignored.…”

Section: Discussionmentioning

confidence: 99%

Human Nephrogenesis can Persist Beyond 40 Postnatal Days in Preterm Infants

Carpenter,

Yarlagadda,

VandenHeuvel

et al. 2024

Kidney International Reports

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“…Differences in kidney volumes between the preterm groups may be due to physiological changes related to placental insufficiency in FGR such as redistribution of fetal blood flow, hypoxia and nutritive impairment, previously associated with permanent changes and increased vulnerability in several organs, including the kidneys [1,2,41]. Further, several interventions associated with neonatal intensive care may have a negative impact on kidney function, at least in the short term [42], but with less knowledge about long-term effects. As indicated by the current results, it may be hypothesized that placental insufficiency, leading to early-onset FGR, sensitizes the kidneys to the adverse effects of neonatal intensive care, also leading to a decrease in kidney volumes in adolescence.…”

Section: Kidney Volumesmentioning

confidence: 99%

Fetal growth restriction followed by very preterm birth is associated with smaller kidneys but preserved kidney function in adolescence

et al. 2022

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Background Preterm birth and fetal growth restriction (FGR) are associated with structural and functional kidney changes, increasing long-term risk for chronic kidney disease and hypertension. However, recent studies in preterm children are conflicting, indicating structural changes but normal kidney function. This study therefore assessed kidney structure and function in a cohort of adolescents born very preterm with and without verified FGR. Methods Adolescents born very preterm with FGR and two groups with appropriate birthweight (AGA) were included; one matched for gestational week at birth and one born at term. Cortical and medullary kidney volumes and T1 and T2* mapping values were assessed by magnetic resonance imaging. Biochemical markers of kidney function and renin–angiotensin–aldosterone system (RAAS) activation were analyzed. Results Sixty-four adolescents were included (13–16 years; 48% girls). Very preterm birth with FGR showed smaller total (66 vs. 75 ml/m2; p = 0.01) and medullary volume (19 vs. 24 ml/m2; p < 0.0001) compared to term AGA. Corticomedullary volume ratio decreased from preterm FGR (2.4) to preterm AGA (2.2) to term AGA (1.9; p = 0.004). There were no differences in T1 or T2* values (all p ≥ 0.34) or in biochemical markers (all p ≥ 0.12) between groups. Conclusions FGR with abnormal fetal blood flow followed by very preterm birth is associated with smaller total kidney and medullary kidney volumes, but not with markers of kidney dysfunction or RAAS activation in adolescence. Decreased total kidney and medullary volumes may still precede a long-term decrease in kidney function, and potentially be used as a prognostic marker. Graphical abstract

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Nephrotoxic medications and associated acute kidney injury in hospitalized neonates

Cited by 19 publications

References 32 publications

Perioperative Neonatal Acute Kidney Injury Is Common: Risk Factors for Poor Outcomes

Perioperative Neonatal Acute Kidney Injury Is Common: Risk Factors for Poor Outcomes

Human Nephrogenesis can Persist Beyond 40 Postnatal Days in Preterm Infants

Fetal growth restriction followed by very preterm birth is associated with smaller kidneys but preserved kidney function in adolescence

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