Preoperative metabolic acidosis and acute kidney injury after open laparotomy in the neonatal intensive care unit

Abstract

Background: This study evaluated potential risk factors associated with acute kidney injury (AKI) in infants undergoing bedside open laparotomy in the neonatal intensive care unit (NICU), and analyzed the association between postoperative AKI and outcomes. Methods: Retrospective data, including neonatal characteristics, perioperative findings (i.e. vital signs and fluid status), postoperative AKI incidence, and postoperative mortality rate of infants who underwent bedside open laparotomy in the NICU between May 2013 and May 2018 were collected and analyzed. Results: A total of 53 cases (26 in AKI group vs 27 in non-AKI group) were analyzed. On univariable analysis, transfusion, pre-and postoperative blood gas analysis and number of inotropic agents, cumulative postoperative percentage fluid overload (48 h), and preoperative hourly urine output were associated with the development of postoperative AKI. On multivariable logistic regression analysis, preoperative acidosis (pH <7.15 or base deficit >10; P = 0.002; OR, 11.067; 95%CI: 2.499-49.017) and preoperative urine output (P = 0.035; OR, 0.548; 95%CI: 0.314-0.959) were significant factors associated with postoperative AKI. Postoperative mortality rate 30 days after surgery was higher in the AKI group, but the difference was not significant. Conclusions: Preoperative metabolic acidosis and urine output are important factors potentially associated with the development of postoperative AKI in neonates undergoing bedside open laparotomy. Strategies such as alkali therapy, which protect the kidney from further injury, should be validated in future studies. A decreasing urine output may suggest deteriorating kidney function prior to surgery, potentially amplifying the risk of postoperative AKI.

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

“…For instance, Yum et al reported an association of open laparotomy in neonates with metabolic acidosis with postoperative neonatal AKI. 21 In our study and similar to the cohort of neonates admitted to the NICU who received at least 48 hours of intravenous fluids, 1 perioperative neonatal AKI was highest in extremely preterm and low birth weight infants. These infants have low nephron number and low renal reserve, in addition to tubular immaturity, which lead to increased susceptibility to abnormal nephrogenesis and kidney injury from all potential insults, including dehydration, nephrotoxic medications, and systemic inflammation.…”

“…Risk factors of AKI in critically ill neonates have been described in multicenter studies [8], however, the risks and comorbidities associated with perioperative neonatal AKI are less defined and mostly reliant on single-center reports. For instance, Yum et al reported an association of open laparotomy in neonates with metabolic acidosis with postoperative neonatal AKI [21].…”

“…For instance, Yum et al reported an association of open laparotomy in neonates with metabolic acidosis with postoperative neonatal AKI. 21…”

Fundamentals and Applications of Electrophoretic Deposition

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