Incidence and risk factors of early onset neonatal AKI

on behalf of the Neonatal Kidney Collaborative

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and objectives Neonatal AKI is associated with poor short- and long-term outcomes. The objective of this study was to describe the risk factors and outcomes of neonatal AKI in the first postnatal week. Design, setting, participants, & measurements The international retrospective observational cohort study, Assessment of World wide AKI Epidemiology in Neonates (AWAKEN), included neonates admitted to a neonatal intensive care unit who received at least 48 hours of intravenous fluids. Early AKI was defined by an increase in serumcreatinine>0.3mg/dl or urine output<1ml/kg per hour on postnatal days 2-7, the neonatal modification of Kidney Disease: Improving Global Outcomes criteria.We assessed risk factors forAKI and associations of AKI with death and duration of hospitalization. ResultsTwenty-onepercent (449of 2110) experienced early AKI.Early AKI was associated with higher riskof death (adjusted odds ratio, 2.8; 95% confidence interval, 1.7 to 4.7) and longer duration of hospitalization (parameter estimate: 7.3 days 95% confidence interval, 4.7 to 10.0), adjusting for neonatal and maternal factors along with medication exposures. Factors associated with a higher risk of AKI included: outborn delivery; resuscitation with epinephrine; admission diagnosis of hyperbilirubinemia, inborn errors of metabolism, or surgical need; frequent kidney function surveillance; and admission to a children’s hospital. Those factors that were associated with a lower risk includedmultiplegestations,cesarean section,andexposuresto antimicrobials,methylxanthines, diuretics,and vasopressors. Risk factors varied by gestational age strata. Conclusions AKI in the first postnatal week is common and associated with death and longer duration of hospitalization. The AWAKEN study demonstrates a number of specific risk factors that should serve as “red flags” for clinicians at the initiation of the neonatal intensive care unit course.

Original languageEnglish (US)
Pages (from-to)184-195
Number of pages12
JournalClinical Journal of the American Society of Nephrology
Volume14
Issue number2
DOIs
StatePublished - Feb 7 2019

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Hospitalization
Neonatal Intensive Care Units
Incidence
Epidemiology
Confidence Intervals
Inborn Errors Metabolism
Hyperbilirubinemia
Kidney Diseases
Diuretics
Resuscitation
Cesarean Section
Epinephrine
Gestational Age
Observational Studies
Cohort Studies
Odds Ratio
Mothers
Urine
Kidney
methylxanthine

ASJC Scopus subject areas

  • Epidemiology
  • Critical Care and Intensive Care Medicine
  • Nephrology
  • Transplantation

Cite this

Incidence and risk factors of early onset neonatal AKI. / on behalf of the Neonatal Kidney Collaborative.

In: Clinical Journal of the American Society of Nephrology, Vol. 14, No. 2, 07.02.2019, p. 184-195.

Research output: Contribution to journalArticle

on behalf of the Neonatal Kidney Collaborative. / Incidence and risk factors of early onset neonatal AKI. In: Clinical Journal of the American Society of Nephrology. 2019 ; Vol. 14, No. 2. pp. 184-195.
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abstract = "Background and objectives Neonatal AKI is associated with poor short- and long-term outcomes. The objective of this study was to describe the risk factors and outcomes of neonatal AKI in the first postnatal week. Design, setting, participants, & measurements The international retrospective observational cohort study, Assessment of World wide AKI Epidemiology in Neonates (AWAKEN), included neonates admitted to a neonatal intensive care unit who received at least 48 hours of intravenous fluids. Early AKI was defined by an increase in serumcreatinine>0.3mg/dl or urine output<1ml/kg per hour on postnatal days 2-7, the neonatal modification of Kidney Disease: Improving Global Outcomes criteria.We assessed risk factors forAKI and associations of AKI with death and duration of hospitalization. ResultsTwenty-onepercent (449of 2110) experienced early AKI.Early AKI was associated with higher riskof death (adjusted odds ratio, 2.8; 95{\%} confidence interval, 1.7 to 4.7) and longer duration of hospitalization (parameter estimate: 7.3 days 95{\%} confidence interval, 4.7 to 10.0), adjusting for neonatal and maternal factors along with medication exposures. Factors associated with a higher risk of AKI included: outborn delivery; resuscitation with epinephrine; admission diagnosis of hyperbilirubinemia, inborn errors of metabolism, or surgical need; frequent kidney function surveillance; and admission to a children’s hospital. Those factors that were associated with a lower risk includedmultiplegestations,cesarean section,andexposuresto antimicrobials,methylxanthines, diuretics,and vasopressors. Risk factors varied by gestational age strata. Conclusions AKI in the first postnatal week is common and associated with death and longer duration of hospitalization. The AWAKEN study demonstrates a number of specific risk factors that should serve as “red flags” for clinicians at the initiation of the neonatal intensive care unit course.",
author = "{on behalf of the Neonatal Kidney Collaborative} and Charlton, {Jennifer R.} and Louis Boohaker and David Askenazi and Brophy, {Patrick D.} and Carl D’Angio and Mamta Fuloria and Jason Gien and Russell Griffin and Sangeeta Hingorani and Susan Ingraham and Ayesa Mian and Ohls, {Robin K.} and Shantanu Rastogi and Rhee, {Christopher J.} and Mary Revenis and Subrata Sarkar and Alexandra Smith and Michelle Starr and Kent, {Alison L.} and Namasivayam Ambalavanan and Selewski, {David T.} and Carolyn Abitbol and Marissa DeFreitas and Ronnie Guillet and Mhanna, {Maroun J.} and Rupesh Raina and Deepak Kumar and Arikan, {Ayse Akcan} and Goldstein, {Stuart L.} and Nathan, {Amy T.} and Kupferman, {Juan C.} and Alok Bhutada and Elizabeth Bonachea and John Mahan and Arwa Nada and Jennifer Jetton and Colaizy, {Tarah T.} and Klein, {Jonathan M.} and Cole, {F. Sessions} and Davis, {T. Keefe} and Joshua Dower and Lawrence Milner and Kimberly Reidy and Kaskel, {Frederick J.} and Gist, {Katja M.} and Hanna, {Mina H.} and Wong, {Craig S.} and Catherine Joseph and Tara DuPont and Amy Staples",
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AU - on behalf of the Neonatal Kidney Collaborative

AU - Charlton, Jennifer R.

AU - Boohaker, Louis

AU - Askenazi, David

AU - Brophy, Patrick D.

AU - D’Angio, Carl

AU - Fuloria, Mamta

AU - Gien, Jason

AU - Griffin, Russell

AU - Hingorani, Sangeeta

AU - Ingraham, Susan

AU - Mian, Ayesa

AU - Ohls, Robin K.

AU - Rastogi, Shantanu

AU - Rhee, Christopher J.

AU - Revenis, Mary

AU - Sarkar, Subrata

AU - Smith, Alexandra

AU - Starr, Michelle

AU - Kent, Alison L.

AU - Ambalavanan, Namasivayam

AU - Selewski, David T.

AU - Abitbol, Carolyn

AU - DeFreitas, Marissa

AU - Guillet, Ronnie

AU - Mhanna, Maroun J.

AU - Raina, Rupesh

AU - Kumar, Deepak

AU - Arikan, Ayse Akcan

AU - Goldstein, Stuart L.

AU - Nathan, Amy T.

AU - Kupferman, Juan C.

AU - Bhutada, Alok

AU - Bonachea, Elizabeth

AU - Mahan, John

AU - Nada, Arwa

AU - Jetton, Jennifer

AU - Colaizy, Tarah T.

AU - Klein, Jonathan M.

AU - Cole, F. Sessions

AU - Davis, T. Keefe

AU - Dower, Joshua

AU - Milner, Lawrence

AU - Reidy, Kimberly

AU - Kaskel, Frederick J.

AU - Gist, Katja M.

AU - Hanna, Mina H.

AU - Wong, Craig S.

AU - Joseph, Catherine

AU - DuPont, Tara

AU - Staples, Amy

PY - 2019/2/7

Y1 - 2019/2/7

N2 - Background and objectives Neonatal AKI is associated with poor short- and long-term outcomes. The objective of this study was to describe the risk factors and outcomes of neonatal AKI in the first postnatal week. Design, setting, participants, & measurements The international retrospective observational cohort study, Assessment of World wide AKI Epidemiology in Neonates (AWAKEN), included neonates admitted to a neonatal intensive care unit who received at least 48 hours of intravenous fluids. Early AKI was defined by an increase in serumcreatinine>0.3mg/dl or urine output<1ml/kg per hour on postnatal days 2-7, the neonatal modification of Kidney Disease: Improving Global Outcomes criteria.We assessed risk factors forAKI and associations of AKI with death and duration of hospitalization. ResultsTwenty-onepercent (449of 2110) experienced early AKI.Early AKI was associated with higher riskof death (adjusted odds ratio, 2.8; 95% confidence interval, 1.7 to 4.7) and longer duration of hospitalization (parameter estimate: 7.3 days 95% confidence interval, 4.7 to 10.0), adjusting for neonatal and maternal factors along with medication exposures. Factors associated with a higher risk of AKI included: outborn delivery; resuscitation with epinephrine; admission diagnosis of hyperbilirubinemia, inborn errors of metabolism, or surgical need; frequent kidney function surveillance; and admission to a children’s hospital. Those factors that were associated with a lower risk includedmultiplegestations,cesarean section,andexposuresto antimicrobials,methylxanthines, diuretics,and vasopressors. Risk factors varied by gestational age strata. Conclusions AKI in the first postnatal week is common and associated with death and longer duration of hospitalization. The AWAKEN study demonstrates a number of specific risk factors that should serve as “red flags” for clinicians at the initiation of the neonatal intensive care unit course.

AB - Background and objectives Neonatal AKI is associated with poor short- and long-term outcomes. The objective of this study was to describe the risk factors and outcomes of neonatal AKI in the first postnatal week. Design, setting, participants, & measurements The international retrospective observational cohort study, Assessment of World wide AKI Epidemiology in Neonates (AWAKEN), included neonates admitted to a neonatal intensive care unit who received at least 48 hours of intravenous fluids. Early AKI was defined by an increase in serumcreatinine>0.3mg/dl or urine output<1ml/kg per hour on postnatal days 2-7, the neonatal modification of Kidney Disease: Improving Global Outcomes criteria.We assessed risk factors forAKI and associations of AKI with death and duration of hospitalization. ResultsTwenty-onepercent (449of 2110) experienced early AKI.Early AKI was associated with higher riskof death (adjusted odds ratio, 2.8; 95% confidence interval, 1.7 to 4.7) and longer duration of hospitalization (parameter estimate: 7.3 days 95% confidence interval, 4.7 to 10.0), adjusting for neonatal and maternal factors along with medication exposures. Factors associated with a higher risk of AKI included: outborn delivery; resuscitation with epinephrine; admission diagnosis of hyperbilirubinemia, inborn errors of metabolism, or surgical need; frequent kidney function surveillance; and admission to a children’s hospital. Those factors that were associated with a lower risk includedmultiplegestations,cesarean section,andexposuresto antimicrobials,methylxanthines, diuretics,and vasopressors. Risk factors varied by gestational age strata. Conclusions AKI in the first postnatal week is common and associated with death and longer duration of hospitalization. The AWAKEN study demonstrates a number of specific risk factors that should serve as “red flags” for clinicians at the initiation of the neonatal intensive care unit course.

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