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Renal Oxygenation (rSO2) Population Parameter Estimates in Premature Infants Routinely Monitored With Near-Infrared Spectroscopy. Adv Neonatal Care 2021; 22:370-377. [PMID: 34417355 DOI: 10.1097/anc.0000000000000927] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Currently, reference ranges for renal oxygenation measured by near-infrared spectroscopy (NIRS) in preterm infants beyond the first days of life are lacking, especially those born prior to 29 weeks' gestation. Population estimates of renal oxygenation (rSO2) levels among preterm infants over time have yet to be established, leading to reluctance in clinical application. PURPOSE To characterize the distribution and estimate population parameters for renal oxygenation measured by NIRS during the first 14 days of life among preterm infants. METHODS We prospectively observed rSO2 trends of 37 infants before 34 weeks' gestation and 1800-g or less birth weight for the first 14 days of life. Analyses included distribution fit tests, ordinary least squares (OLS) regression, and t tests. RESULTS Average daily rSO2 variation steadily increased with 42% difference through the first 14 days of life. For all infants, renal rSO2 means peaked during the first 3 days of life and plateaued around 7 days. Daily rSO2 slopes were significantly lower among males and infants 29 weeks' or less gestation. IMPLICATIONS FOR PRACTICE Renal rSO2 during the first 14 days of life reflects normal extrauterine transition reaching stabilization around 7 days of life. Gestational age, birth weight, and gender may predict the early trajectory of rSO2 patterns. Population estimates provide parameters for renal rSO2 that may indicate early-onset tissue hypoxia when acute or significant drops from baseline occur. IMPLICATIONS FOR RESEARCH We present a framework to guide future research using renal NIRS technology in preterm infants to determine deviations from expected trends that may precede renal injury.
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Kavanaugh KJ, Jetton JG, Kent AL. Neonatal Acute Kidney Injury: Understanding of the Impact on the Smallest Patients. Crit Care Clin 2021; 37:349-363. [PMID: 33752860 DOI: 10.1016/j.ccc.2020.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The study of neonatal acute kidney injury (AKI) has transitioned from small, single-center studies to the development of a large, multicenter cohort. The scope of research has expanded from assessment of incidence and mortality to analysis of more specific risk factors, novel urinary biomarkers, interplay between AKI and other organ systems, impact of fluid overload, and quality improvement efforts. The intensification has occurred through collaboration between the neonatology and nephrology communities. This review discusses 2 case scenarios to illustrate the clinical presentation of neonatal AKI, important risk factors, and approaches to minimize AKI events and adverse long-term outcomes.
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Affiliation(s)
- Keegan J Kavanaugh
- Stead Family Department of Pediatrics, University of Iowa, 200 Hawkins Drive, 2015-26 BT, Iowa City, IA 52241, USA
| | - Jennifer G Jetton
- Division of Pediatric Nephrology, Dialysis, and Transplantation, Stead Family Department of Pediatrics, University of Iowa, 200 Hawkins Drive, 2029 BT, Iowa City, IA 52241, USA.
| | - Alison L Kent
- Division of Neonatology, Golisano Children's Hospital, University of Rochester School of Medicine, 601 Elmwood Avenue, Box 651, Rochester, NY 14642, USA; College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory 2601, Australia. https://twitter.com/Aussiekidney
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Soares H, Moita R, Maneira P, Gonçalves A, Gomes A, Flor-de-Lima F, Costa S, Soares P, Pissarra S, Rocha G, Silva J, Clemente F, Pinto H, Guimarães H. Nephrotoxicity in Neonates. Neoreviews 2021; 22:e506-e520. [PMID: 34341158 DOI: 10.1542/neo.22-8-e506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Acute kidney injury (AKI) is classified based on prerenal, intrinsic, and postrenal causes. In the newborn, AKI can occur after an insult during the prenatal, perinatal, or postnatal period. AKI is usually an underrecognized condition and its true incidence is unknown. AKI may result from the administration of a number of different nephrotoxic medications, which are often used concurrently in critically ill neonates, exponentially increasing the risk of renal injury. Drug toxicity may also compromise the formation and development of nephrons, and this is particularly important in preterm infants, who have incomplete nephrogenesis. Little is known about the pharmacokinetics and pharmacodynamics of different medications used in neonates, especially for the most immature infant, and the use of most medications in this population is off label. Strategies to prevent AKI include the avoidance of hypotension, hypovolemia, fluid imbalances, hypoxia, and sepsis as well as judicious use of nephrotoxic medications. Treatment strategies aim to maintain fluids and electrolytic and acid-base homeostasis, along with an adequate nutritional status. Neonates are especially prone to long-term sequelae of AKI and benefit from long-term follow-up. This review summarizes the most relevant aspects of nephrotoxicity in neonates and describes the prevention, treatment, and follow-up of AKI in neonates.
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Affiliation(s)
- Henrique Soares
- Neonatal Intensive Care Unit, Neonatology Department.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine of Porto University, Porto, Portugal
| | - Rita Moita
- Neonatal Intensive Care Unit, Neonatology Department.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine of Porto University, Porto, Portugal
| | - Pedro Maneira
- Neonatal Intensive Care Unit, Neonatology Department
| | | | - Ana Gomes
- Neonatal Intensive Care Unit, Neonatology Department.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine of Porto University, Porto, Portugal
| | - Filipa Flor-de-Lima
- Neonatal Intensive Care Unit, Neonatology Department.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine of Porto University, Porto, Portugal
| | - Sandra Costa
- Neonatal Intensive Care Unit, Neonatology Department.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine of Porto University, Porto, Portugal
| | - Paulo Soares
- Neonatal Intensive Care Unit, Neonatology Department
| | - Susana Pissarra
- Neonatal Intensive Care Unit, Neonatology Department.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine of Porto University, Porto, Portugal
| | - Gustavo Rocha
- Neonatal Intensive Care Unit, Neonatology Department.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine of Porto University, Porto, Portugal
| | - Jorge Silva
- Neonatal Intensive Care Unit, Neonatology Department.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine of Porto University, Porto, Portugal
| | - Fátima Clemente
- Neonatal Intensive Care Unit, Neonatology Department.,Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine of Porto University, Porto, Portugal
| | - Helena Pinto
- Neonatal Intensive Care Unit, Neonatology Department.,Pediatrics Nephrology Unit, Pediatric Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Hercília Guimarães
- Department of Gynecology-Obstetrics and Pediatrics, Faculty of Medicine of Porto University, Porto, Portugal
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Abstract
BACKGROUND Acute kidney injury (AKI) affects approximately 30% of infants admitted to the neonatal intensive care unit (NICU), and increases mortality risk by 50%. Current diagnostic criteria (serum creatinine rise with oliguria) cannot detect early-onset AKI, as up to 50% of nephron damage may occur by the time these abnormalities present. Once AKI is established, clinical management is often ineffective; therefore, prevention is key. Near-infrared spectroscopy (NIRS) offers a feasible, noninvasive approach to continuously monitor renal oxygenation trends over time, serving as a surrogate marker for renal perfusion. PURPOSE To provide an overview of NIRS principles for measuring renal oxygenation, and to describe current evidence of how this technology is being used among infants admitted to the NICU relative to the prediction and identification of AKI. METHODS A comprehensive search of PubMed and CINHAL focused on renal NIRS studies in NICU preterm and term infants was conducted. RESULTS Findings from 34 studies were included. In term infants, reduced renal oxygenation correlated to invasive SvO2 monitoring, predicted survivability and AKI. In preterm infants, reduced renal oxygenation was associated with AKI in one study, yet contrasting findings were reported in those with patent ductus arteriosus, including those who received prostaglandin inhibitors. Normative data in all infants were sparse. IMPLICATIONS FOR PRACTICE Renal NIRS may offer a noninvasive measurement of kidney hypoperfusion that may precede conventional diagnostic measures. IMPLICATIONS FOR RESEARCH Normative data are lacking, the threshold for renal ischemia is not defined, and consensus guiding clinical treatment based on NIRS data is nonexistent.
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Bozkurt O, Yucesoy E. Acute Kidney Injury in Neonates with Perinatal Asphyxia Receiving Therapeutic Hypothermia. Am J Perinatol 2021; 38:922-929. [PMID: 31986537 DOI: 10.1055/s-0039-1701024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the incidence and severity of acute kidney injury (AKI) and evaluate risk factors that predict AKI in asphyxiated infants receiving therapeutic hypothermia. STUDY DESIGN Infants ≥36 weeks' gestation diagnosed with moderate-to-severe perinatal asphyxia and received therapeutic hypothermia were reviewed retrospectively (n = 166). Modified Acute Kidney Injury Network criteria were used to diagnose AKI. The results of infants with AKI were compared with the infants who did not develop AKI. RESULTS AKI developed in 49 (29.5%) infants, of whom 22 had stage I, 13 had stage II, and 14 had stage III AKI. The overall mortality rate was 15.7% and was significantly higher in infants with AKI when compared with infants without AKI (41 vs. 5%; p < 0.001). Asystole at birth (p = 0.044), placental abruption (p = 0.041), outborn status (p = 0.041), need for vasopressor support (p = 0.031), increased bleeding tendency (p = 0.031), initial lactate level (p = 0.015), and 12-hour lactate level (p = 0.029) were independent risk factors for the development of AKI. Receiver operating characteristic curve analysis demonstrated a good predictive value for initial lactate level (>15 mmol/L), with 69% sensitivity (95% CI: 55-82) and 82% specificity (95% CI: 74-89), and for 12-hour lactate level (>6 mmol/L), with 83.7% sensitivity (95% CI: 70-93) and 73.5% specificity (95% CI: 64.5-81), to predict AKI. CONCLUSION AKI is still a common complication of perinatal asphyxia despite treatment with therapeutic hypothermia. Identification of risk factors associated with the development of AKI in asphyxiated infants would be potentially beneficial to reduce morbidity and mortality. Besides perinatal risk factors, initial and 12-hour lactate concentrations can be used for the early prediction of AKI.
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Affiliation(s)
- Ozlem Bozkurt
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Demiroglu Bilim University, Istanbul, Turkey
| | - Ebru Yucesoy
- Division of Neonatology, Department of Pediatrics, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey
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Beken S, Akbulut BB, Albayrak E, Güner B, Ünlü Y, Temur B, Aydin S, Ödemiş E, Erek E, Korkmaz A. Evaluation of neonatal acute kidney injury after critical congenital heart disease surgery. Pediatr Nephrol 2021; 36:1923-1929. [PMID: 33492453 DOI: 10.1007/s00467-020-04890-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 11/11/2020] [Accepted: 12/02/2020] [Indexed: 12/01/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common complication of congenital heart diseases (CHDs) after cardiac surgery. This study aimed to define the frequency and critical course, risk factors and short-term outcomes of AKI in postoperative CHD neonates. METHODS Postoperatively followed term CHD newborn infants were enrolled in the study. Infants with congenital anomalies of the urinary tract and other major congenital anomalies were excluded. Neonatal modified KDIGO criteria were used to assess AKI. RESULTS A total of 199 postoperatively followed newborn infants were included in the study. Acute kidney injury was detected in 71 (35.6%) patients. Of these patients, 24 (33.8%) were in stage 1, 14 (19.7%) in stage 2, and 33 (46.5%) in stage 3. Acute kidney injury occurred within the first week (median 1 day [IQR 1-2 days]) of cardiac surgery in 93% of the patients. The duration of invasive respiratory support and extracorporeal membrane oxygenation (ECMO) and mortality were significantly higher in stage 3 patients. Higher vasoactive-inotropic score (OR, 1.02; 95% CI, 1.0-1.04; p = 0.008) and receiving ECMO (OR, 7.9; 95% CI, 2.6-24.4; p = 0.001) were associated with risk for the development of AKI. The mortality rate was 52.1% in the AKI (+) patients, and having AKI (OR 7.1; 95% CI, 3.5-14.18) was significantly associated with mortality. CONCLUSION Acute kidney injury, a common early complication after critical neonatal CHD cardiac surgery, is associated with increased morbidity and mortality. Stage 3 AKI is associated with significantly higher mortality rates.
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Affiliation(s)
- Serdar Beken
- Department of Pediatrics, Neonatology Subdivision, Acıbadem University School of Medicine, İstanbul, Turkey.
| | - Burcu Bulum Akbulut
- Department of Pediatrics, Pediatric Nephrology Subdivision, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Eda Albayrak
- Neonatal Intensive Care Unit, Acıbadem Mehmet Ali Aydınlar University, Atakent Hospital, İstanbul, Turkey
| | - Bengisu Güner
- Department of Pediatrics, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Yasemin Ünlü
- Neonatal Intensive Care Unit, Acıbadem Mehmet Ali Aydınlar University, Atakent Hospital, İstanbul, Turkey
| | - Bahar Temur
- Department of Cardiovascular Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Selim Aydin
- Department of Cardiovascular Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Ender Ödemiş
- Department of Pediatrics Pediatric Cardiology Subdivision, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Ersin Erek
- Department of Cardiovascular Surgery, Acıbadem University School of Medicine, İstanbul, Turkey
| | - Ayşe Korkmaz
- Department of Pediatrics, Neonatology Subdivision, Acıbadem University School of Medicine, İstanbul, Turkey
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Turner SS, Davidson JM, Elabiad MT. Changes in urinary kidney injury molecule-1 levels after blood transfusions in preterm infants. Sci Rep 2021; 11:11690. [PMID: 34083688 PMCID: PMC8175397 DOI: 10.1038/s41598-021-91209-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 05/24/2021] [Indexed: 11/14/2022] Open
Abstract
Literature supports an association between transfusions and gut injury in preterm infants. We hypothesized that packed red blood (PRBC) transfusions are associated with kidney inflammation marked by a rise in urinary levels of Kidney Injury Molecule 1 (KIM-1). Prospectively, KIM-1 levels were measured before and then at 6, 12 and 24 h after a PRBC transfusion. Results are presented as mean (± SD) and median (IQR). Thirty-four infants, birth weight 865 (± 375) g, had higher pretransfusion KIM-1 levels of 2270 (830, 3250) pg/mg than what is normal for age. These were not associated with hematocrit levels. KIM-1 levels peaked between 6 and 12 h after the transfusion. Levels peaked to 3300 (1990, 6830) pg/mg; levels returned to pretransfusion levels of 2240 (1240, 3870) pg/mg by 24 h, p < 0.01. The 24-h post-transfusion KIM-1 levels were similar to pretransfusion levels, p = 0.63. PRBC transfusions in preterm infants are associated with an elevation in urinary KIM-1 levels. The mechanism of this association may be important in studying transfusion associated organ injury. KIM-1, as an inflammatory marker, may be helpful in assessing the effect of different transfusion volumes or in evaluating operational thresholds of anemia in premature infants.
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Affiliation(s)
- Stephanie S Turner
- Ochsner Baptist Medical Center, 2700 Napoleon Ave, New Orleans, LA, 70115, USA
| | - Jennifer M Davidson
- Department of Pediatrics, Division of Neonatology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA
| | - Mohamad T Elabiad
- Department of Pediatrics, Division of Neonatology, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, 38163, USA.
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Ponthier L, Trigolet M, Chianea T, Mons F, Yardin C, Guigonis V, El Hamel C. Distribution of proteinuria- and albuminuria-to-creatinine ratios in preterm newborns. Pediatr Nephrol 2021; 36:1515-1524. [PMID: 33394192 DOI: 10.1007/s00467-020-04838-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/18/2020] [Accepted: 10/21/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Urine protein assessment is important when glomerular disease or injury is suspected. Normal values of proteinuria already published for preterm newborns suffer from limitation, with small cohorts of patients. This prospective study was conducted to update the urine total protein- and albumin-to-creatinine ratio values. METHODS Urine samples were collected from 231 preterm newborns within the first 48 h (D0-1) and/or between 72-120 h of life (D3-4). Total protein, albumin, and creatinine were measured, their distribution and upper-limit values determined. RESULTS At D0-1 and D3-4, respectively, the median for the total protein-to-creatinine ratio were 80 and 107 mg/mmol (upper-limit values 223 and 289 mg/mmol) in the whole studied population, 149 and 214 mg/mmol in children born before 29 weeks of gestational age, 108 and 130 mg/mmol in those born between 29 and 33 weeks, and 61 and 93 mg/mmol in those born after 33 weeks. For the albumin-to-creatinine ratio, the median were 12 and 17 mg/mmol (upper-limit values 65 and 62 mg/mmol) in the whole studied population, 22 and 50 mg/mmol in children born before 29 weeks, 21 mg/mmol in those born between 29 and 33 weeks, and 8 and 12 mg/mmol in those born after 33 weeks. The use of nephrotoxic drugs and mechanical ventilation seems to influence proteinuria and albuminuria values. CONCLUSIONS We report distribution of proteinuria- and albuminuria-to-creatinine in preterm newborns, including the upper-limit values. These values should be taken into account in the detection and diagnosis of glomerular disease and/or injury in daily clinical practice. Graphical abstract.
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Affiliation(s)
- Laure Ponthier
- Collection Biologique Hôpital de la Mère et de l'Enfant (CB-HME), University Hospital Center, 8 Avenue Dominique Larrey, 87042 Cedex, Limoges, France.,Department of Pediatric, University Hospital Center, Limoges, France
| | - Marine Trigolet
- Department of Pediatric, University Hospital Center, Limoges, France
| | - Thierry Chianea
- Department of Biochemistry, University Hospital Center, Limoges, France
| | - Fabienne Mons
- Department of Pediatric, University Hospital Center, Limoges, France
| | - Catherine Yardin
- Collection Biologique Hôpital de la Mère et de l'Enfant (CB-HME), University Hospital Center, 8 Avenue Dominique Larrey, 87042 Cedex, Limoges, France.,Department of Cytogenetics and clinical genetics, University Hospital Center, Limoges, France.,CNRS, XLIM, UMR7252, Limoges University, Limoges, France
| | - Vincent Guigonis
- Collection Biologique Hôpital de la Mère et de l'Enfant (CB-HME), University Hospital Center, 8 Avenue Dominique Larrey, 87042 Cedex, Limoges, France.,Department of Pediatric, University Hospital Center, Limoges, France
| | - Chahrazed El Hamel
- Collection Biologique Hôpital de la Mère et de l'Enfant (CB-HME), University Hospital Center, 8 Avenue Dominique Larrey, 87042 Cedex, Limoges, France. .,Department of Pediatric, University Hospital Center, Limoges, France.
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Abdi HH, Backes CH, Ball MK, Talavera-Barber MM, Klebanoff MA, Jadcherla SR, Mohamed TH, Slaughter JL. Prophylactic Indomethacin in extremely preterm infants: association with death or BPD and observed early serum creatinine levels. J Perinatol 2021; 41:749-755. [PMID: 33664466 PMCID: PMC8052281 DOI: 10.1038/s41372-021-00995-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 01/20/2021] [Accepted: 02/04/2021] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To identify the relationship between prophylactic indomethacin (PI) administration and (1) mortality and bronchopulmonary dysplasia (BPD) at 36-week postmenstrual age (PMA) (primary outcome), and (2) to evaluate for PI-associated acute kidney injury. STUDY DESIGN Retrospective cohort investigation of 22-28 weeks gestation infants (N = 1167) who were admitted to Nationwide Children's Hospital on postnatal days 0-1 between May 2009 and September 2017 and survived ≥24-h postnatal. The associations of PI treatment with mortality or BPD, and other secondary outcomes, were evaluated via multivariable robust-error-variance Poisson regression. RESULTS The adjusted risks of death or BPD (1.02, 95% CI: 0.83, 1.25), BPD (0.97, 95% CI: 0.77, 1.21), and death 1.33 (95% CI: 0.84, 2.10) by 36-week PMA were unchanged following PI treatment after multivariable adjustment. No changes in mean creatinine levels were detected in exposed versus unexposed infants to suggest PI-induced AKI. CONCLUSION Prophylactic indomethacin treatment was unrelated to mortality or BPD outcomes.
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Affiliation(s)
- Hibo H. Abdi
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Carl H. Backes
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA,Division of Neonatology, Nationwide Children’s Hospital, Columbus, Ohio, USA,The Heart Center, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Molly K. Ball
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA,Division of Neonatology, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Maria M. Talavera-Barber
- Avera Research Institute Center for Pediatric and Community Research, Avera McKenna Hospital and University Healtch Center, Sioux Falls, South Dakota, USA
| | - Mark A. Klebanoff
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA,Department of Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Sudarshan R. Jadcherla
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA,Division of Neonatology, Nationwide Children’s Hospital, Columbus, Ohio, USA,Innovative Infant Feeding Disorders Research Program, Nationwide Children’s Hospital, Columbus, Ohio, USA,Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Tahagod H. Mohamed
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA,Division of Nephrology, Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - Jonathan L. Slaughter
- Center for Perinatal Research, Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, USA,Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, Ohio, USA,Division of Neonatology, Nationwide Children’s Hospital, Columbus, Ohio, USA,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
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Kandasamy Y, Rudd D. Cystatin C: A more reliable biomarker of renal function in young infants? A longitudinal cohort study. Acta Paediatr 2021; 110:1341-1345. [PMID: 32799396 PMCID: PMC7984386 DOI: 10.1111/apa.15538] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/11/2020] [Accepted: 08/13/2020] [Indexed: 12/17/2022]
Abstract
Aim We carried out a longitudinal cohort study to measure serial CysC (Cystatin C) in a cohort of neonates born preterm until the age of 2 years. We hypothesised that CysC levels are independent of body weight and would not vary with gestational age. Methods This prospective cohort study was conducted from August 2014 until October 2016, and follow‐up was completed in October 2018. Preterm infants at less than 28 weeks of gestation (extremely preterm infants) were recruited and followed up until the age of 24 months. Blood samples for measurement of CysC were collected at regular intervals. Results We recruited 58 preterm neonates with mean gestation was 26.2 (1.5) weeks, and a mean birth weight was 917 (140) g. One‐way analysis of variance (ANOVA) did not show any significant difference in CysC levels between 28, 32 and 37 weeks' gestation (P = .09) despite a significant increase in body weight (P < .001). The mean CysC level was higher in the neonatal period and subsequently plateaued by 24 months. Conclusion Serum CysC level is independent of body weight and not influenced by postnatal age nor by gender.
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Affiliation(s)
- Yogavijayan Kandasamy
- Department of Neonatology The Townsville Hospital Douglas Qld Australia
- Mothers and Babies Research Centre Hunter Medical Research Institute HMRIThe University of Newcastle Newcastle NSW Australia
- College of Medicine and Dentistry James Cook University Douglas Qld Australia
| | - Donna Rudd
- College of Public Health, Medical and Veterinary Sciences James Cook University Douglas Qld Australia
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Heo JS, Lee JM. The Long-Term Effect of Preterm Birth on Renal Function: A Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18062951. [PMID: 33805740 PMCID: PMC8001027 DOI: 10.3390/ijerph18062951] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 12/29/2022]
Abstract
The preterm-born adult population is ever increasing following improved survival rates of premature births. We conducted a meta-analysis to investigate long-term effects of preterm birth on renal function in preterm-born survivors. We searched PubMed and EMBASE to identify studies that compared renal function in preterm-born survivors and full-term-born controls, published until 2 February 2019. A random effects model with standardized mean difference (SMD) was used for meta-analyses. Heterogeneity of the studies was evaluated using Higgin’s I2 statistics. Risk of bias was assessed using the Newcastle–Ottawa quality assessment scale. Of a total of 24,388 articles screened, 27 articles were finally included. Compared to full-term-born controls, glomerular filtration rate and effective renal plasma flow were significantly decreased in preterm survivors (SMD −0.54, 95% confidence interval (CI), −0.85 to −0.22, p = 0.0008; SMD −0.39, 95% CI, −0.74 to −0.04, p = 0.03, respectively). Length and volume of the kidneys were significantly decreased in the preterm group compared to the full-term controls (SMD −0.73, 95% CI, −1.04 to −0.41, p < 0.001; SMD −0.82, 95% CI, −1.05 to −0.60, p < 0.001, respectively). However, serum levels of blood urea nitrogen, creatinine, and cystatin C showed no significant difference. The urine microalbumin to creatinine ratio was significantly increased in the preterm group. Both systolic and diastolic blood pressures were also significantly elevated in the preterm group, although the plasma renin level did not differ. This meta-analysis demonstrates that preterm-born survivors may be subject to decreased glomerular filtration, increased albuminuria, decreased kidney size and volume, and hypertension even though their laboratory results may not yet deteriorate.
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Affiliation(s)
- Ju Sun Heo
- Department of Pediatrics, Anam Hospital, Korea University College of Medicine, Seoul 02841, Korea;
| | - Jiwon M. Lee
- Department of Pediatrics, Chungnam National University Hospital, Daejeon 35015, Korea
- Department of Pediatrics, Chungnam National University College of Medicine, Daejeon 35015, Korea
- Correspondence: ; Tel.: +82-42-280-7152
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Dorum BA, Ozkan H, Cetinkaya M, Koksal N. Regional oxygen saturation and acute kidney injury in premature infants. Pediatr Int 2021; 63:290-294. [PMID: 32634851 DOI: 10.1111/ped.14377] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/22/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Decreased renal blood flow plays a vital role in the etiology of acute kidney injury (AKI). In this study, we aim to investigate the role of renal regional oxygen saturation (rSO2 ) reductions in predicting AKI in the first 24 h of life. METHODS One hundred premature babies with a gestational age of ≤32 weeks were included. Renal and cerebral rSO2 s were monitored for 24 h by near-infrared spectroscopy. Infants were followed up for the first 7 days for the diagnosis of AKI. RESULTS Infants' median gestational age was 29 (23-32) weeks, and their birthweight was 1,192 ± 355 g. It was found that the renal rSO2 values were lower in the first 24 h of life in patients who developed AKI, and this decrease was statistically significant in the first 6 h of life. CONCLUSIONS The low renal rSO2 values in the early hours of life in premature babies may have a role in predicting AKI.
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Affiliation(s)
- Bayram Ali Dorum
- Department of Neonatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Hilal Ozkan
- Department of Neonatology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Merih Cetinkaya
- Department of Neonatology, Ministry of Health University of Health Science Kanuni Sultan Suleyman Research and Training Hospital, Istanbul, Turkey
| | - Nilgun Koksal
- Department of Neonatology, Faculty of Medicine, Uludag University, Bursa, Turkey
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Capelli I, Vitali F, Zappulo F, Martini S, Donadei C, Cappuccilli M, Leonardi L, Girardi A, Aiello V, Galletti S, Faldella G, Poluzzi E, DE Ponti F, Gaetano LAM. Biomarkers of Kidney Injury in Very-low-birth-weight Preterm Infants: Influence of Maternal and Neonatal Factors. In Vivo 2021; 34:1333-1339. [PMID: 32354927 DOI: 10.21873/invivo.11910] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 01/27/2020] [Accepted: 01/29/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND/AIM Acute kidney injury is an important cause of mortality in very-low-birth-weight (VLBW) preterm infants. As in the general population, the detection of renal damage cannot rely on the measurement of serum creatinine, since it has been demonstrated to be a weak predictor and a delayed indicator of kidney function deterioration. However, several candidate biomarkers have failed to prove sufficient specificity and sensitivity for a routine clinical use because of the poor awareness of their biological role. This study was aimed to investigate the impact of different maternal and neonatal conditions on several renal biomarkers in VLBW preterm infants during the first week of life. PATIENTS AND METHODS Preterm infants<32 weeks' gestation and <1500g were enrolled. We measured urinary biomarkers kidney injury molecule 1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), cystatin C, epidermal growth factor (EGF) and osteopontin (OPN) on the 1st, 3rd, and 7th day after birth. RESULTS Thirty-tree infants were included. The multivariate analysis showed a significant association between gestational age, the presence of patent ductus arteriosus, antenatal maternal hypertension and the levels of urinary biomarkers. CONCLUSION There is a possible relation between early biomarkers of renal injury and antenatal, perinatal and post-natal characteristics in VLBW preterm infants during the first week of life.
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Affiliation(s)
- Irene Capelli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Francesca Vitali
- Department of Medical and Surgical Sciences, Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Fulvia Zappulo
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Silvia Martini
- Department of Medical and Surgical Sciences, Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Chiara Donadei
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Maria Cappuccilli
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Luca Leonardi
- Department of Medical and Surgical Sciences, Pharmacology Unit, University of Bologna, Bologna, Italy
| | - Anna Girardi
- Department of Medical and Surgical Sciences, Pharmacology Unit, University of Bologna, Bologna, Italy
| | - Valeria Aiello
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Silvia Galletti
- Department of Medical and Surgical Sciences, Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Giacomo Faldella
- Department of Medical and Surgical Sciences, Neonatal Intensive Care Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Elisabetta Poluzzi
- Department of Medical and Surgical Sciences, Pharmacology Unit, University of Bologna, Bologna, Italy
| | - Fabrizio DE Ponti
- Department of Medical and Surgical Sciences, Pharmacology Unit, University of Bologna, Bologna, Italy
| | - LA Manna Gaetano
- Department of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola-Malpighi University Hospital, University of Bologna, Bologna, Italy
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Ayoub D, Elmashad A, Rowisha M, Eltomey M, El Amrousy D. Hemodynamic effects of high-frequency oscillatory ventilation in preterm neonates with respiratory distress syndrome. Pediatr Pulmonol 2021; 56:424-432. [PMID: 33289301 DOI: 10.1002/ppul.25195] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/28/2020] [Accepted: 11/27/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND High-frequency oscillatory ventilation (HFOV) can have negative hemodynamic effects in neonates. We aimed to assess systemic, cerebral, and cardiac hemodynamic changes in preterm neonates with respiratory distress syndrome (RDS) on HFOV. METHODS This observational study was conducted from June 2017 until May 2019 on 100 preterm neonates with RDS that needed switching from conventional mechanical ventilation to HFOV. Initial and Follow up capillary blood gas, echocardiographic examination, cranial ultrasound, and Doppler study of cerebral, celiac, superior mesenteric, and renal arteries using resistive index (RI) were performed before, 24 h, and 72 h after the use of HFOV. RESULTS There was no statistically significant difference as regards cardiac function, heart rate, or intraventricular hemorrhage on follow up measurements. However blood pressure, left ventricular dimensions, and volumes statistically increased after HFOV. There was a statistically significant decrease in the pulmonary artery systolic pressure after the use of HFOV. After the use of HFOV, there was a statistically significant increase in the superior vena cava flow and left ventricular output while right ventricular output values initially increased then slightly decreased but still higher than the initial values. RI of cerebral, superior mesenteric, celiac, and renal arteries significantly decreased on follow up measurements which reflected increased blood flow in these arteries. CONCLUSION HFOV had no negative effect on the cerebral, systemic, or cardiac hemodynamics when applied at optimum MAP. Therefore, concerns about negative hemodynamic effects of HFOV should not discourage the use of HFOV when deemed clinically indicated provided the use of optimum MAP.
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Affiliation(s)
- Dalia Ayoub
- Pediatric Department, Tanta University Hospital, Tanta, Egypt
| | | | - Mohamed Rowisha
- Pediatric Department, Tanta University Hospital, Tanta, Egypt
| | - Mohamed Eltomey
- Diagnostic Radiology Department, Tanta University Hospital, Tanta, Egypt
| | - Doaa El Amrousy
- Pediatric Department, Tanta University Hospital, Tanta, Egypt
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65
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Salerno SN, Liao Y, Jackson W, Greenberg RG, McKinzie CJ, McCallister A, Benjamin DK, Laughon MM, Sanderson K, Clark RH, Gonzalez D. Association between Nephrotoxic Drug Combinations and Acute Kidney Injury in the Neonatal Intensive Care Unit. J Pediatr 2021; 228:213-219. [PMID: 32818481 PMCID: PMC7752849 DOI: 10.1016/j.jpeds.2020.08.035] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 08/06/2020] [Accepted: 08/13/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To determine the incidence of acute kidney injury (AKI) in infants exposed to nephrotoxic drug combinations admitted to 268 neonatal intensive care units managed by the Pediatrix Medical Group. STUDY DESIGN We included infants born at 22-36 weeks gestational age, ≤120 days postnatal age, exposed to nephrotoxic drug combinations, with serum creatinine measurements available, and discharged between 2007 and 2016. To identify risk factors associated with a serum creatinine definition of AKI based on the Kidney Disease: Improving Global Outcomes criteria, we performed multivariable logistic and Cox regression adjusting for gestational age, sex, birth weight, postnatal age, race/ethnicity, sepsis, respiratory distress syndrome, baseline serum creatinine, and duration of combination drug exposure. The adjusted odds of AKI were determined relative to gentamicin + indomethacin for the following nephrotoxic drug combinations: chlorothiazide + ibuprofen; chlorothiazide + indomethacin; furosemide + gentamicin; furosemide + ibuprofen; furosemide + tobramycin; ibuprofen + spironolactone; and vancomycin + piperacillin-tazobactam. RESULTS Among 8286 included infants, 1384 (17%) experienced AKI. On multivariable analysis, sepsis, lower baseline creatinine, and duration of combination therapy were associated with increased odds of AKI. Furosemide + tobramycin and vancomycin + piperacillin-tazobactam were associated with a decreased risk of AKI relative to gentamicin + indomethacin in both the multivariable and Cox regression models. CONCLUSIONS In this cohort, infants receiving longer durations of nephrotoxic combination therapy had an increased odds of developing AKI.
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Affiliation(s)
- Sara N. Salerno
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yuting Liao
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Wesley Jackson
- Department of Pediatrics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rachel G. Greenberg
- Department of Pediatrics, Duke University School of Medicine, Durham, NC, USA,Duke Clinical Research Institute, Durham, NC, USA
| | - Cameron J. McKinzie
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | - Ashley McCallister
- Department of Pharmacy, University of North Carolina Medical Center, Chapel Hill, NC, USA
| | | | - Matthew M. Laughon
- Department of Pediatrics, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Keia Sanderson
- Department of Medicine-Nephrology, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Reese H. Clark
- MEDNAX Center for Research, Education, Quality and Safety, Sunrise, FL, USA
| | - Daniel Gonzalez
- Division of Pharmacotherapy and Experimental Therapeutics, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Unal ET, Ozer EA, Kahramaner Z, Erdemir A, Cosar H, Sutcuoglu S. Value of urinary kidney injury molecule-1 levels in predicting acute kidney injury in very low birth weight preterm infants. J Int Med Res 2020; 48:300060520977442. [PMID: 33372811 PMCID: PMC7783886 DOI: 10.1177/0300060520977442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Objective This study aimed to evaluate the significance of urinary kidney injury
molecule-1 (uKIM-1) levels in predicting acute kidney injury (AKI) and
mortality in very low birth weight (VLBW) preterm infants. Methods This prospective, observational cohort study was conducted on 39 VLBW preterm
infants. Serum creatinine (SCr) and uKIM-1 levels were measured in the first
24 and 48 to 72 hours of life. The estimated glomerular filtration rate
(eGFR) was calculated. Levels of uKIM-1 were measured with an enzyme-linked
immunosorbent assay. Results Among 39 VLBW infants, 9 (23%) developed AKI. The mortality rate was 17.9%
(n = 7 neonates). There was no significant difference in SCr levels, uKIM-1
levels, or the eGFR obtained in the first 24 hours in the AKI group compared
with controls. However, significant differences were found in SCr and uKIM-1
levels, and the eGFR rate at 48 to 72 hours between the groups. Levels of
uKIM-1 were significantly higher in non-survivors than in survivors in the
first 24 and 48 to 72 hours of life. Conclusion The level of uKIM-1 can be used as a simple noninvasive diagnostic method for
predicting AKI and mortality, especially within 48 to 72 hours of life. Clinical trial registration: We do not have a clinical trial
registration ID. In Turkey, clinical trial registration is not required for
non-drug, noninvasive, clinical studies.
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Affiliation(s)
- Ebru Turkoglu Unal
- Department of Neonatology, Sisli Etfal Training and Research Hospital, Istanbul, Turkey
| | - Esra Arun Ozer
- Department of Pediatrics, Tinaztepe University Faculty of Medicine, Izmir, Turkey
| | - Zelal Kahramaner
- Department of Neonatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Aydin Erdemir
- Department of Neonatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Hese Cosar
- Department of Neonatology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Sumer Sutcuoglu
- Department of Neonatology, Tepecik Training and Research Hospital, Izmir, Turkey
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Aviles-Otero N, Ransom M, Weitkamp J, Charlton JR, Sullivan BA, Kaufman DA, Fairchild KD. Urinary tract infections in very low birthweight infants: A two-center analysis of microbiology, imaging and heart rate characteristics. J Neonatal Perinatal Med 2020; 14:269-276. [PMID: 33136069 DOI: 10.3233/npm-200513] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Increased understanding of characteristics of urinary tract infection (UTI) among very low birthweight infants (VLBW) might lead to improvement in detection and treatment. Continuous monitoring for abnormal heart rate characteristics (HRC) could provide early warning of UTIs. OBJECTIVE Describe the characteristics of UTI, including HRC, in VLBW infants. METHODS We reviewed records of VLBW infants admitted from 2005-2010 at two academic centers participating in a randomized clinical trial of HRC monitoring. Results of all urine cultures, renal ultrasounds (RUS), and voiding cystourethrograms (VCUG) were assessed. Change in the HRC index was analyzed before and after UTI. RESULTS Of 823 VLBW infants (27.7±2.9 weeks GA, 53% male), 378 had > / = 1 urine culture obtained. A UTI (≥10,000 CFU and >five days of antibiotics) was diagnosed in 80 infants, (10% prevalence, mean GA 25.8±2.0 weeks, 76% male). Prophylactic antibiotics were administered to 29 (36%) infants after UTI, of whom four (14%) had another UTI. Recurrent UTI also occurred in 7/51 (14%) of infants not on uroprophylaxis after their first UTI. RUS was performed after UTI in 78%, and hydronephrosis and other major anomalies were found in 19%. A VCUG was performed in 48% of infants and 18% demonstrated vesicoureteral reflux (VUR). The mean HRC rose and fell significantly in the two days before and after diagnosis of UTI. CONCLUSIONS UTI was diagnosed in 10% of VLBW infants, and the HRC index increased prior to diagnosis, suggesting that continuous HRC monitoring in the NICU might allow earlier diagnosis and treatment of UTI.
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Affiliation(s)
- N Aviles-Otero
- Department of Pediatrics, Division of Neonatology, University of Virginia, Charlottesville, VA, USA
| | - M Ransom
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J Weitkamp
- Department of Pediatrics, Division of Neonatology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - J R Charlton
- Department of Pediatrics, Division of Nephrology, University of Virginia, Charlottesville, VA, USA
| | - B A Sullivan
- Department of Pediatrics, Division of Neonatology, University of Virginia, Charlottesville, VA, USA
| | - D A Kaufman
- Department of Pediatrics, Division of Neonatology, University of Virginia, Charlottesville, VA, USA
| | - K D Fairchild
- Department of Pediatrics, Division of Neonatology, University of Virginia, Charlottesville, VA, USA
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68
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Muk T, Jiang PP, Stensballe A, Skovgaard K, Sangild PT, Nguyen DN. Prenatal Endotoxin Exposure Induces Fetal and Neonatal Renal Inflammation via Innate and Th1 Immune Activation in Preterm Pigs. Front Immunol 2020; 11:565484. [PMID: 33193334 PMCID: PMC7643587 DOI: 10.3389/fimmu.2020.565484] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/31/2020] [Indexed: 12/29/2022] Open
Abstract
Chorioamnionitis (CA) predisposes to preterm birth and affects the fetal mucosal surfaces (i.e., gut, lungs, and skin) via intra-amniotic (IA) inflammation, thereby accentuating the proinflammatory status in newborn preterm infants. It is not known if CA may affect more distant organs, such as the kidneys, before and after preterm birth. Using preterm pigs as a model for preterm infants, we investigated the impact of CA on fetal and neonatal renal status and underlying mechanisms. Fetal pigs received an IA dose of lipopolysaccharide (LPS), were delivered preterm by cesarean section 3 days later (90% gestation), and compared with controls (CON) at birth and at postnatal day 5. Plasma proteome and inflammatory targets in kidney tissues were evaluated. IA LPS-exposed pigs showed inflammation of fetal membranes, higher fetal plasma creatinine, and neonatal urinary microalbumin levels, indicating renal dysfunction. At birth, plasma proteomics revealed LPS effects on proteins associated with renal inflammation (up-regulated LRG1, down-regulated ICA, and ACE). Kidney tissues of LPS pigs at birth also showed increased levels of kidney injury markers (LRG1, KIM1, NGLA, HIF1A, and CASP3), elevated molecular traits related to innate immune activation (infiltrated MPO+ cells, complement molecules, oxidative stress, TLR2, TLR4, S100A9, LTF, and LYZ), and Th1 responses (CD3+ cells, ratios of IFNG/IL4, and TBET/GATA3). Unlike in plasma, innate and adaptive immune responses in kidney tissues of LPS pigs persisted to postnatal day 5. We conclude that prenatal endotoxin exposure induces fetal and postnatal renal inflammation in preterm pigs with both innate and adaptive immune activation, partly explaining the potential increased risks of kidney injury in preterm infants born with CA.
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Affiliation(s)
- Tik Muk
- Section for Comparative Paediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Ping-Ping Jiang
- Section for Comparative Paediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark.,School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Allan Stensballe
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Kerstin Skovgaard
- Department of Biotechnology and Biomedicine, Technical University of Denmark, Copenhagen, Denmark
| | - Per Torp Sangild
- Section for Comparative Paediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Paediatrics, Odense University Hospital, Odense, Denmark
| | - Duc Ninh Nguyen
- Section for Comparative Paediatrics and Nutrition, Department of Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
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Dalmasso C, Chade AR, Mendez M, Giani JF, Bix GJ, Chen KC, Loria AS. Intrarenal Renin Angiotensin System Imbalance During Postnatal Life Is Associated With Increased Microvascular Density in the Mature Kidney. Front Physiol 2020; 11:1046. [PMID: 32982785 PMCID: PMC7491414 DOI: 10.3389/fphys.2020.01046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/30/2020] [Indexed: 12/17/2022] Open
Abstract
Environmental stress during early life is an important factor that affects the postnatal renal development. We have previously shown that male rats exposed to maternal separation (MatSep), a model of early life stress, are normotensive but display a sex-specific reduced renal function and exacerbated angiotensin II (AngII)-mediated vascular responses as adults. Since optimal AngII levels during postnatal life are required for normal maturation of the kidney, this study was designed to investigate both short- and long-term effect of MatSep on (1) the renal vascular architecture and function, (2) the intrarenal renin-angiotensin system (RAS) components status, and (3) the genome-wide expression of genes in isolated renal vasculature. Renal tissue and plasma were collected from male rats at different postnatal days (P) for intrarenal RAS components mRNA and protein expression measurements at P2, 6, 10, 14, 21, and 90 and microCT analysis at P21 and 90. Although with similar body weight and renal mass trajectories from P2 to P90, MatSep rats displayed decreased renal filtration capacity at P90, while increased microvascular density at both P21 and P90 (p < 0.05). MatSep increased renal expression of renin, and angiotensin type 1 (AT1) and type 2 (AT2) receptors (p < 0.05), but reduced ACE2 mRNA expression and activity from P2-14 compared to controls. However, intrarenal levels of AngII peptide were reduced (p < 0.05) possible due to the increased degradation to AngIII by aminopeptidase A. In isolated renal vasculature from neonates, Enriched Biological Pathways functional clusters (EBPfc) from genes changed by MatSep reported to modulate extracellular structure organization, inflammation, and pro-angiogenic transcription factors. Our data suggest that male neonates exposed to MatSep could display permanent changes in the renal microvascular architecture in response to intrarenal RAS imbalance in the context of the atypical upregulation of angiogenic factors.
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Affiliation(s)
- Carolina Dalmasso
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, United States
| | - Alejandro R. Chade
- Department of Physiology and Biophysics, Medicine, and Radiology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Mariela Mendez
- Department of Internal Medicine, Hypertension and Vascular Research Division, Henry Ford Hospital, Detroit, MI, United States
| | - Jorge F. Giani
- Departments of Biomedical Sciences and Pathology, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Gregory J. Bix
- Clinical Neuroscience Research Center, Tulane University, New Orleans, LA, United States
| | - Kuey C. Chen
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, United States
| | - Analia S. Loria
- Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY, United States
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Abstract
Acute kidney injury (AKI) is a highly prevalent disease entity in the NICU, affecting nearly one-quarter of critically ill neonates by some reports. Though medical management remains the mainstay in the treatment of AKI, renal replacement therapy (RRT) is indicated when conservative measures are unable to maintain electrolytes, fluid balance, toxins, or waste products within a safe margin. Several modalities of RRT exist for use in neonatal populations, including peritoneal dialysis, hemodialysis, and continuous RRT. It is the aim of this review to introduce each of these RRT modalities, as well as to discuss their technical considerations, benefits, indications, contraindications, and complications.
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Affiliation(s)
| | - Jason M Misurac
- Division of Nephrology, Dialysis, and Transplantation, University of Iowa Stead Family Children's Hospital, Iowa City, IA
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Acute Kidney Injury Guidelines Are Associated With Improved Recognition and Follow-up for Neonatal Patients. Adv Neonatal Care 2020; 20:269-275. [PMID: 31567184 DOI: 10.1097/anc.0000000000000664] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studies demonstrate that neonatal acute kidney injury (AKI) is associated with increased morbidity and mortality. Acute kidney injury survivors are at risk for renal dysfunction and chronic kidney disease and require long-term follow-up. PURPOSE To maximize identification of AKI and ensure referral, we created guidelines for diagnosis, evaluation, and management of AKI. METHODS/SEARCH STRATEGY Retrospective cohort study of neonatal intensive care unit patients treated before guideline implementation (cohort 1; n = 175) and after (cohort 2; n = 52). Outcome measures included AKI incidence, documented diagnosis, and pediatric nephrology consultation. Statistical methods included t tests, Fisher exact tests, and Wilcoxon rank sum tests. FINDINGS/RESULTS We found 68 AKI episodes in 52 patients in cohort 1 and 15 episodes in 12 patients in cohort 2. Diagnosis and documentation of AKI improved after guideline implementation (C1:24/68 [35%], C2: 12/15 [80%]; P = .003) as did pediatric nephrology consultation (C1:12/68 [18%]; C2: 12/15 [80%]; P < .001) and outpatient referral (C1: 3/47 [6%], C2:5/8 [63%]; P < .01). IMPLICATIONS FOR PRACTICE Neonatal AKI guideline implementation was associated with improvements in recognition, diagnosis, and inpatient and outpatient nephrology consultation. Early recognition and diagnosis along with specialist referral may improve outcomes among neonatal AKI survivors, ensuring appropriate future monitoring and long-term follow-up. IMPLICATIONS FOR RESEARCH Future research should continue to determine the long-term implications of early diagnosis of AKI and appropriate subspecialty care with follow-up.
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Cai C, Qiu G, Hong W, Shen Y, Gong X. Clinical effect and safety of continuous renal replacement therapy in the treatment of neonatal sepsis-related acute kidney injury. BMC Nephrol 2020; 21:286. [PMID: 32682407 PMCID: PMC7368639 DOI: 10.1186/s12882-020-01945-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 07/12/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Sepsis is the leading cause of acute kidney injury (AKI) in the neonatal intensive care unit (NICU). The aim of the study is to explore the efficacy and security of continuous renal replacement therapy (CRRT) in the treatment of neonatal sepsis-related AKI. METHOD Totally12 sepsis-related AKI neonates treated with CRRT were hospitalized in the NICU of Shanghai Children's Hospital between November 2012 and November 2019, and the clinical data of these 12 cases were retrospectively analyzed. Renal function, acid-base balance, electrolytes, blood pressure and hemodynamics indexes were recorded before CRRT initiation, 12/24/48 h after CRRT initiation and at the end of CRRT respectively. The efficacy of CRRT was evaluated and the clinical outcome was observed in these 12 sepsis-related AKI neonates. Repeated measurement analysis of variance was used for statistical analysis of the data. RESULT (1) Continuous veno-venous hemodialysis filtration (CVVHDF) was used in 12 cases of sepsis-related AKI neonates. There were 6 cases with oliguria, 3 cases with fluid overload (FO), 3 cases with septic shock. The duration of CRRT was 49 ~ 110 h, average (76.2 ± 23.5) h. (2) The blood pressure (BP) of 12 sepsis -related AKI neonates could reach the normal level (40-60 mmHg) 12 h after CRRT initiation, and the normal BP level could be maintained during the CRRT treatment. After 12 h CRRT, the blood pH value increased to the normal range (7.35 ~ 7.45). After 12 h CRRT treatment, the oxygenation index of 12sepsis-related AKI neonates could reach 200 mmHg. After 24 h CRRT treatment, it could rise to more than 300 mmHg. Serum potassium, serum urea nitrogen and serum creatinine levels decreased significantly 12 h after CRRT initiation, and reached the normal range 24 h after CRRT initiation. The urine volume significantly increased 24 h after CRRT initiation. (3) Venous catheterization was performed successfully in all sepsis-related AKI neonates. We observed 2 cases of thrombocytopenia, 1 case of obstruction and 1 case of hypotension in the course of CRRT. There were no complications such as hypothermia, hemorrhage, thrombosis and infection.11 neonates were cured and discharged. One neonate was treated with CRRT and passed through the oliguria stage of AKI, but died after the parents gave up the treatment. CONCLUSIONS It is safe and effective to treat neonatal sepsis-related AKI with CRRT, which should be an effective measure for the treatment of sepsis-related AKI neonates.
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Affiliation(s)
- Cheng Cai
- Department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062 China
| | - Gang Qiu
- Department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062 China
| | - Wenchao Hong
- Department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062 China
| | - Yunlin Shen
- Department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062 China
| | - Xiaohui Gong
- Department of Neonatology, Shanghai Children’s Hospital, Shanghai Jiao Tong University, No.355, Luding Road, Shanghai, 200062 China
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73
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Primack W, Kleeman S, Boineau F, Jernigan S. Are My Pediatric Patients at Increased Risk of Developing Chronic Kidney Disease? Clin Pediatr (Phila) 2020; 59:801-808. [PMID: 32400181 DOI: 10.1177/0009922820920015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic kidney disease (CKD) is an underrecognized and often undiagnosed cause of morbidity and mortality. Many children and adolescents are at increased risk of developing CKD as they mature and age, secondary to conditions commonly cared for by pediatric health professionals. Prematurity, diabetes mellitus, hypertension, congenital heart disease, sickle cell disease and trait, severe obesity, cancer chemotherapy, other drug toxicities, and systemic situations that may cause acute kidney injury such as sepsis or extracorporeal membrane oxygenation therapy predispose to potential CKD. Clinicians should be aware of these conditions in order to screen for CKD, choose non-nephrotoxic treatments for these children whenever possible, and treat or refer those who have early signs of CKD.
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74
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Germovsek E, Osborne L, Gunaratnam F, Lounis SA, Busquets FB, Standing JF, Sinha AK. Development and external evaluation of a population pharmacokinetic model for continuous and intermittent administration of vancomycin in neonates and infants using prospectively collected data. J Antimicrob Chemother 2020; 74:1003-1011. [PMID: 30668696 DOI: 10.1093/jac/dky525] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Revised: 11/05/2018] [Accepted: 11/16/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Vancomycin is commonly used for nosocomial bacterial pathogens causing late-onset septicaemia in preterm infants. We prospectively collected pharmacokinetic data aiming to describe pharmacokinetics and determine covariates contributing to the variability in neonatal vancomycin pharmacokinetics. Further, we aimed to use the model to compare the ratio of AUC24 at steady-state to the MIC (AUC24,ss/MIC) of several intermittent and continuous dosing regimens. METHODS Newborns receiving vancomycin for suspected or confirmed late-onset sepsis were included. Peak and trough concentrations for intermittent vancomycin dosing and steady-state concentrations for continuous vancomycin dosing were measured. NONMEM 7.3 was used for population pharmacokinetic analysis. Monte Carlo simulations were performed to compare dosing schemes. RESULTS Data from 54 infants were used for model development and from 34 infants for the model evaluation {corrected gestational age [median (range)] = 29 (23.7-41.9) weeks and 28 (23.4-41.7) weeks, respectively}. The final model was a one-compartment model. Weight and postmenstrual age were included a priori, and then no additional covariate significantly improved the model fit. Final model parameter estimates [mean (SEM)]: CL = 5.7 (0.3) L/h/70 kg and V = 39.3 (3.7) L/70 kg. Visual predictive check of the evaluation dataset confirmed the model can predict external data. Simulations using MIC of 1 mg/L showed that for neonates with gestational age ≤25 weeks and postnatal age ≤2 weeks AUC24,ss/MIC was lower with the intermittent regimen (median 482 versus 663). CONCLUSIONS A population pharmacokinetic model for continuous and intermittent vancomycin administration in infants was developed. Continuous administration might be favourable for treating infections caused by resistant microorganisms in very young and immature infants.
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Affiliation(s)
- Eva Germovsek
- Inflammation, Infection and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, UK.,Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Leanne Osborne
- Neonatal Unit, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, Whitechapel, London, UK
| | - Flora Gunaratnam
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, UK
| | - Shehrazed A Lounis
- Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, UK
| | - Ferran Bossacoma Busquets
- Inflammation, Infection and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, UK.,Hospital Sant Joan de Deu, Passeig Hospital Sant Joan de Deu 2, Barcelona, Spain
| | - Joseph F Standing
- Inflammation, Infection and Rheumatology Section, UCL Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, UK
| | - Ajay K Sinha
- Neonatal Unit, Royal London Hospital, Barts Health NHS Trust, Whitechapel Road, Whitechapel, London, UK.,Centre for Genomics and Child Health, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, 4 Newark Street, London, UK
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75
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Abstract
PURPOSE OF REVIEW Pediatric acute kidney injury (AKI) in critically ill patients is associated with increased morbidity and mortality. Emerging data support that the incidence of pediatric AKI in the ICU is rising. For children with severe AKI, renal replacement therapy (RRT) can provide a lifesaving supportive therapy. The optimal timing to deliver and modality by which to deliver RRT remain a point of discussion within pediatric (and adult) literature. This review discusses the use of RRT for pediatric patients in the ICU. We discuss the most recent evidence-based methods for RRT with a focus on continuous RRT. RECENT FINDINGS The feasibility of dialyzing the smallest infants and more medically complex children in the ICU is dependent on the advancements in dialysis access and circuit technology. At present, data indicate that upward of 27% of children in the ICU develop AKI and 6% require RRT. Newer dialysis modalities including prolonged intermittent hemodialysis and continuous flow peritoneal dialysis as well as newer dialysis technologies such as the smaller volume circuits (e.g., Cardio-Renal Pediatric Dialysis Emergency Machine, Newcastle Infant Dialysis and Ultrafiltration System) have made the provision of dialysis safer and more effective for pediatric patients of a variety of sizes. SUMMARY Renal replacement in the ICU requires a multidisciplinary team approach that is facilitated by a pediatric nephrologist in conjunction with intensivists and skilled nursing staff. Although mortality rates for children on dialysis remain high, outcomes are improving with the support of the multidisciplinary team and dialysis technology advancements.
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76
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Sharma S, Sen A, Kaur C. Renal function status after 6 months in term sick newborns with acute kidney injury. J Clin Neonatol 2020. [DOI: 10.4103/jcn.jcn_8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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77
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Yang MC, Liu HK, Wu HY, Tey SL, Yang YN, Wu CY, Wu JR. Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern. Front Pediatr 2020; 8:591441. [PMID: 33194925 PMCID: PMC7649389 DOI: 10.3389/fped.2020.591441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 09/28/2020] [Indexed: 01/09/2023] Open
Abstract
Background: Patent ductus arteriosus (PDA) with a bidirectional shunt reflects critical clinical conditions. The operability of PDA with a bidirectional shunt in pre-term infants is still not clearly clarified. This study aimed to investigate the feasibility and the outcomes of PDA ligation in pre-term infants with a bidirectional shunt PDA. Methods: All pre-term infants receiving PDA ligation between 2013 and 2019 were enrolled in this prospective study. Patients were allocated into two groups based on the shunting direction of PDA, which were the left-to-right group (group A) and the bidirectional group (group B). Clinical characteristics and pre-op comorbidities were analyzed. Intraoperative complications, post-op neurological sequelae, necrotizing enterocolitis, survival, and mortality were compared between these two groups. Results: Thirty-seven pre-term infants were enrolled (18 in group A, 19 in group B). The mean post-menstrual age at PDA surgery was 32.0 ± 1.3 and 32.8 ± 1.5 weeks, respectively. Before surgery, 44.4 and 89.5% (group A vs. B) of the patients were using invasive mechanical ventilator (p < 0.01). The requirement of high-frequency oscillatory ventilatory support was significantly higher in group B. PDA rupture-related bleeding during exposing PDA or ligating PDA occurred in four infants, and all were all in group B, including one with delayed hemothorax. Early surgical mortality within 30 days of surgery was higher in group B (0 vs. 21.1%, p < 0.05), but only one death could be attributed to the surgery, which was caused by a pain-induced pulmonary hypertension crisis. The 5-year survival was 100% in group A, and 73.7% in group B (p < 0.05). Conclusion: We did not recommend routine PDA ligation in pre-term infants with a bidirectional shunt. However, a bidirectional shunt should not be an absolute contraindication if they fulfill indications of PDA closure. Unexpected intraoperative PDA rupture and delayed hemothorax in a bidirectional shunt PDA should be carefully monitored. Aggressive post-op pain control is also warranted to avoid pulmonary hypertension crisis. The post-op early mortality rate was higher in the bidirectional group, which could be inherent to their poor pre-operative lung condition. Only one death was directly related to the surgery.
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Affiliation(s)
- Ming-Chun Yang
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan.,School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Hsien-Kuan Liu
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Hsuan-Yin Wu
- School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan.,Division of Cardiovascular Surgery, Department of Surgery, E-Da Hospital, Kaohsiung City, Taiwan
| | - Shu-Leei Tey
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan.,School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, Taiwan
| | - Yung-Ning Yang
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan.,School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, Taiwan.,School of Medicine for International Students, I-Shou University, Kaohsiung City, Taiwan
| | - Chien-Yi Wu
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan.,School of Chinese Medicine for Post Baccalaureate, I-Shou University, Kaohsiung City, Taiwan
| | - Jiunn-Ren Wu
- Department of Pediatrics, E-Da Hospital, Kaohsiung City, Taiwan
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78
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Abstract
Preterm birth is associated with adverse renal health outcomes including hypertension, chronic kidney disease, and an increased rate of progression to end-stage renal failure. This review explores the antenatal, perinatal, and postnatal factors that affect the functional nephron mass of an individual and contribute to long-term kidney outcome. Health-care professionals have opportunities to increase their awareness of the risks to kidney health in this population. Optimizing maternal health around the time of conception and during pregnancy, providing kidney-focused supportive care in the NICU during postnatal nephrogenesis, and avoiding accelerating nephron loss throughout life may all contribute to improved long-term outcomes. There is a need for ongoing research into the long-term kidney outcomes of preterm survivors in mid-to-late adulthood as well as a need for further research into interventions that may improve ex utero nephrogenesis.
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Affiliation(s)
- Amanda Dyson
- Centenary Hospital for Women and Children and Department of Neonatology, Canberra Hospital, Woden, Australia
- Australian National University, Canberra, Australia
| | - Alison L Kent
- University of Rochester and Division of Neonatology, Golisano Children's Hospital at URMC, Rochester, NY
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79
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The Effect of Levosimendan Versus Milrinone on the Occurrence Rate of Acute Kidney Injury Following Congenital Heart Surgery in Infants: A Randomized Clinical Trial. Pediatr Crit Care Med 2019; 20:947-956. [PMID: 31274775 DOI: 10.1097/pcc.0000000000002017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVES It has been shown that, in contrast to other inotropic agents, levosimendan improves glomerular filtration rate after adult cardiac surgery. The aim of this study was to investigate the efficacy of levosimendan, compared with milrinone, in preventing acute kidney dysfunction in infants after open-heart surgery with cardiopulmonary bypass. DESIGN Two-center, double-blinded, prospective, randomized clinical trial. SETTING The study was performed in two tertiary pediatric centers, one in Sweden (Gothenburg) and one in Finland (Helsinki). PATIENTS Infants between 1 and 12 months old, diagnosed with Tetralogy of Fallot, complete atrioventricular septal defect or nonrestrictive ventricular septal defect, undergoing total corrective cardiac surgery with cardiopulmonary bypass. INTERVENTIONS Seventy-two infants were randomized to receive a perioperative infusion of levosimendan (0.1 µg/kg/min) or milrinone (0.4 µg/kg/min). The infusion was initiated at the start of cardiopulmonary bypass and continued for 26 hours. MEASUREMENTS AND MAIN RESULTS The primary outcome variable was the absolute value of serum creatinine data on postoperative day 1. Secondary outcomes included the following: 1) acute kidney injury according to the serum creatinine criteria of the Kidney Diseases: Improving Global Outcomes; 2) acute kidney injury with serum creatinine corrected for fluid balance; 3) plasma neutrophil gelatinase-associated lipocalin; 4) cystatin C; 5) urea; 6) lactate; 7) hemodynamic variables; 8) use of diuretics in the PICU; 9) need of dialysis; 10) length of ventilator therapy; and 11) length of PICU stays. There was no significant difference in postoperative serum creatinine between the treatment groups over time (p = 0.65). The occurrence rate of acute kidney injury within 48 hours was 46.9% in the levosimendan group and 39.5% in the milrinone group (p = 0.70). There were no significant differences in other secondary outcome variables between the groups. CONCLUSIONS Levosimendan compared with milrinone did not reduce the occurrence rate of acute kidney injury in infants after total corrective heart surgery for atrioventricular septal defect, ventricular septal defect, or Tetralogy of Fallot.
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80
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Charlton JR, Boohaker L, Askenazi D, Brophy PD, D'Angio C, Fuloria M, Gien J, Griffin R, Hingorani S, Ingraham S, Mian A, Ohls RK, Rastogi S, Rhee CJ, Revenis M, Sarkar S, Smith A, Starr M, Kent AL. Incidence and Risk Factors of Early Onset Neonatal AKI. Clin J Am Soc Nephrol 2019. [PMID: 34497098 DOI: 10.2215/cjn.03670318.2019.2.test] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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 Worldwide 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 serum creatinine >0.3 mg/dl or urine output <1 ml/kg per hour on postnatal days 2-7, the neonatal modification of Kidney Disease: Improving Global Outcomes criteria. We assessed risk factors for AKI and associations of AKI with death and duration of hospitalization. RESULTS Twenty-one percent (449 of 2110) experienced early AKI. Early AKI was associated with higher risk of 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 included multiple gestations, cesarean section, and exposures to 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. CLINICAL TRIAL REGISTRY NAME AND REGISTRATION NUMBER Assessment of Worldwide AKI Epidemiology in Neonates (AWAKEN), NCT02443389.
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Affiliation(s)
| | - Louis Boohaker
- University of Alabama at Birmingham, Birmingham, Alabama
| | - David Askenazi
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Patrick D Brophy
- Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Carl D'Angio
- Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Mamta Fuloria
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Jason Gien
- Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | | | - Sangeeta Hingorani
- Seattle Children's Hospital/University of Washington, Seattle, Washington
| | - Susan Ingraham
- Kapi'olani Medical Center for Women and Children, Honolulu, Hawaii
| | - Ayesa Mian
- Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Robin K Ohls
- University of New Mexico, Albuquerque, New Mexico
| | | | | | - Mary Revenis
- Children's National Medical Center, The George Washington University School of Medicine and The Health Sciences, Washington, DC
| | - Subrata Sarkar
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan; and
| | | | - Michelle Starr
- Seattle Children's Hospital/University of Washington, Seattle, Washington
| | - Alison L Kent
- Golisano Children's Hospital, University of Rochester, Rochester, New York
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81
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Perico N, Askenazi D, Cortinovis M, Remuzzi G. Maternal and environmental risk factors for neonatal AKI and its long-term consequences. Nat Rev Nephrol 2019; 14:688-703. [PMID: 30224767 DOI: 10.1038/s41581-018-0054-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Acute kidney injury (AKI) is a common and life-threatening complication in critically ill neonates. Gestational risk factors for AKI include premature birth, intrauterine growth restriction and low birthweight, which are associated with poor nephron development and are often the consequence of pre-gestational and gestational factors, such as poor nutritional status. Our understanding of how to best optimize renal development and prevent AKI is in its infancy; however, the identification of pre-gestational and gestational factors that increase the risk of adverse neonatal outcomes and the implementation of interventions, such as improving nutritional status early in pregnancy, have the potential to optimize fetal growth and reduce the risk of preterm birth, thereby improving kidney health. The overall risk of AKI among critically ill and premature neonates is exacerbated postnatally as these infants are often exposed to dehydration, septic shock and potentially nephrotoxic medications. Strategies to improve outcomes - for example, through careful evaluation of nephrotoxic drugs - may reduce the incidence of AKI and its consequences among this population. Management strategies and updated technology that will support neonates with AKI are greatly needed. Extremely premature infants and those who survive an episode of AKI should be screened for chronic kidney disease until early adulthood. Here, we provide an overview of our current understanding of neonatal AKI, focusing on its relationship to preterm birth and growth restriction. We describe factors that prevent optimal nephrogenesis during pregnancy and provide a framework for future explorations designed to maximize outcomes in this vulnerable population.
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Affiliation(s)
- Norberto Perico
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - David Askenazi
- Pediatric and Infant Center for Acute Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Monica Cortinovis
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy. .,Unit of Nephrology and Dialysis, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy. .,L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
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82
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Majed B, Bateman DA, Uy N, Lin F. Patent ductus arteriosus is associated with acute kidney injury in the preterm infant. Pediatr Nephrol 2019; 34:1129-1139. [PMID: 30706125 DOI: 10.1007/s00467-019-4194-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 01/03/2019] [Accepted: 01/09/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND This study aimed to test the hypothesis that a patent ductus arteriosus (PDA) is independently associated with acute kidney injury (AKI) in neonates ≤ 28 weeks gestation. METHODS Preterm infants with echocardiographic diagnosis of moderate-large PDA at age ≤ 30 days were studied retrospectively. AKI, the primary outcome, was defined and staged according to serum creatinine using Kidney Disease Improving Global Outcomes (KDIGO) neonatal criteria. Its association with the timing and duration of PDA, non-steroidal anti-inflammatory drugs (NSAIDs) and other nephrotoxic exposures, gestational age, and other covariates was evaluated using mixed-effects logistic regression models. RESULTS Acute Kidney Injury occurred in 49% (101/206) of infants. Moderate-to-large PDA was associated with any-stage AKI (OR 5.31, 95% CI 3.75 to 7.53), stage 1 (mild) AKI (OR 4.86, 95% CI 3.12 to 7.56), and stages 2-3 (severe) AKI (OR 10.9, 95% CI 5.70 to 20.8). NSAID treatment added additional risk for mild AKI (OR 2.45, 95% CI 1.61 to 3.71). Severe AKI was less likely when NSAID treatment was effective (OR 0.45, 95% CI 0.21 to 0.97) but not when ineffective (OR 1.63, 95% CI 0.76 to 3.50). CONCLUSIONS Moderate-to-large PDA was strongly associated with all stages of AKI in preterm infants ≤ 28 weeks of gestational age. Effective NSAID treatment decreased the risk of severe but not mild AKI. These differential effects reflect the balance between the renal benefits of PDA closure and the risk of NSAID toxicity.
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Affiliation(s)
- Batoule Majed
- Department of Pediatrics, Division of Pediatric Nephrology, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, 10032, USA
| | - David A Bateman
- Department of Pediatrics, Division of Neonatology, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, 10032, USA.
| | - Natalie Uy
- Department of Pediatrics, Division of Pediatric Nephrology, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, 10032, USA
| | - Fangming Lin
- Department of Pediatrics, Division of Pediatric Nephrology, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, NY, 10032, USA.
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83
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Kamath N, Luyckx VA. Increasing Awareness of Early Risk of AKI in Neonates. Clin J Am Soc Nephrol 2019; 14:172-174. [PMID: 37128122 PMCID: PMC6390910 DOI: 10.2215/cjn.13461118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Nivedita Kamath
- Department of Pediatric Nephrology, St. John’s Medical College Hospital, Bangalore, India; and
| | - Valerie A. Luyckx
- Institute of Biomedical Ethics and the History of Medicine, University of Zurich, Zurich, Switzerland
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84
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Charlton JR, Boohaker L, Askenazi D, Brophy PD, D'Angio C, Fuloria M, Gien J, Griffin R, Hingorani S, Ingraham S, Mian A, Ohls RK, Rastogi S, Rhee CJ, Revenis M, Sarkar S, Smith A, Starr M, Kent AL. Incidence and Risk Factors of Early Onset Neonatal AKI. Clin J Am Soc Nephrol 2019; 14:184-195. [PMID: 31738181 PMCID: PMC6390916 DOI: 10.2215/cjn.03670318] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/05/2018] [Indexed: 11/23/2022]
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 Worldwide 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 serum creatinine >0.3 mg/dl or urine output <1 ml/kg per hour on postnatal days 2-7, the neonatal modification of Kidney Disease: Improving Global Outcomes criteria. We assessed risk factors for AKI and associations of AKI with death and duration of hospitalization. RESULTS Twenty-one percent (449 of 2110) experienced early AKI. Early AKI was associated with higher risk of 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 included multiple gestations, cesarean section, and exposures to 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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Affiliation(s)
| | - Louis Boohaker
- University of Alabama at Birmingham, Birmingham, Alabama
| | - David Askenazi
- University of Alabama at Birmingham, Birmingham, Alabama
| | - Patrick D Brophy
- Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Carl D'Angio
- Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Mamta Fuloria
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Jason Gien
- Children's Hospital Colorado, University of Colorado, Aurora, Colorado
| | | | - Sangeeta Hingorani
- Seattle Children's Hospital/University of Washington, Seattle, Washington
| | - Susan Ingraham
- Kapi'olani Medical Center for Women and Children, Honolulu, Hawaii
| | - Ayesa Mian
- Golisano Children's Hospital, University of Rochester, Rochester, New York
| | - Robin K Ohls
- University of New Mexico, Albuquerque, New Mexico
| | | | | | - Mary Revenis
- Children's National Medical Center, The George Washington University School of Medicine and The Health Sciences, Washington, DC
| | - Subrata Sarkar
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan; and
| | | | - Michelle Starr
- Seattle Children's Hospital/University of Washington, Seattle, Washington
| | - Alison L Kent
- Golisano Children's Hospital, University of Rochester, Rochester, New York
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85
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Bonsante F, Ramful D, Binquet C, Samperiz S, Daniel S, Gouyon JB, Iacobelli S. Low Renal Oxygen Saturation at Near-Infrared Spectroscopy on the First Day of Life Is Associated with Developing Acute Kidney Injury in Very Preterm Infants. Neonatology 2019; 115:198-204. [PMID: 30645992 DOI: 10.1159/000494462] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/13/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a frequent complication in preterm infants, and the identification of early markers of renal hypoperfusion is a chief challenge in neonatal intensive care units. OBJECTIVES To describe the association between early markers of cardiovascular function and renal perfusion with AKI occurrence in a cohort of preterm infants < 32 weeks' gestation. METHODS 128 infants were prospectively included from birth to discharge. During the first day of life, we assessed cardiovascular function, systemic and organ blood flow by Doppler ultrasound, and monitored cerebral and renal regional oxygen saturation (rSO2) using near-infrared spectroscopy (NIRS). These measures were analyzed in relation to developing AKI and serum creatinine (SCr) peak from day 2 to 7 of life. RESULTS 12 of 128 infants presented with AKI (9.4%). SCr peak was 155.3 ± 30.2 µmol/L in infants with AKI versus 82.0 ± 16.5 in non-AKI infants (p < 0.001). Among all measures of cardiovascular function and renal perfusion, low mean cerebral and renal rSO2 during the first day of life and a low resistive index at renal artery Doppler were significantly associated with developing AKI. After adjustment for possible confounding factors, low renal rSO2 on the first day of life remained associated with a high SCr peak from day 2 to 7 of life. CONCLUSION Low renal rSO2 values during the first day of life correlate with developing AKI in preterm infants < 32 weeks' gestation. NIRS monitoring of renal function during adaptation seems promising, and its very early use after birth to detect kidney hemodynamic dysfunction deserves further investigations.
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Affiliation(s)
- Francesco Bonsante
- Centre d'Etudes Périnatales de l'Océan Indien (EA 7388), CHU La Réunion, Site Sud, Saint Pierre, France.,Néonatologie, Réanimation Néonatale et Pédiatrique, CHU La Réunion, Site Sud, Saint Pierre, France
| | - Duksha Ramful
- Service de Réanimation Néonatale et Infantile, CHU Felix Guyon de La Réunion, Saint Denis, France
| | - Christine Binquet
- Module Épidémiologie Clinique, CIC1432, INSERM, Dijon, France.,Module Épidémiologie Clinique/Essais Cliniques, Centre d'Investigation Clinique, Centre Hospitalier Universitaire Dijon-Bourgogne, Dijon, France
| | - Sylvain Samperiz
- Service de Réanimation Néonatale et Infantile, CHU Felix Guyon de La Réunion, Saint Denis, France
| | - Sandrine Daniel
- Module Épidémiologie Clinique, CIC1432, INSERM, Dijon, France.,Module Épidémiologie Clinique/Essais Cliniques, Centre d'Investigation Clinique, Centre Hospitalier Universitaire Dijon-Bourgogne, Dijon, France
| | - Jean-Bernard Gouyon
- Centre d'Etudes Périnatales de l'Océan Indien (EA 7388), CHU La Réunion, Site Sud, Saint Pierre, France.,Néonatologie, Réanimation Néonatale et Pédiatrique, CHU La Réunion, Site Sud, Saint Pierre, France
| | - Silvia Iacobelli
- Centre d'Etudes Périnatales de l'Océan Indien (EA 7388), CHU La Réunion, Site Sud, Saint Pierre, France, .,Néonatologie, Réanimation Néonatale et Pédiatrique, CHU La Réunion, Site Sud, Saint Pierre, France,
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86
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Sigurjonsdottir VK, Chaturvedi S, Mammen C, Sutherland SM. Pediatric acute kidney injury and the subsequent risk for chronic kidney disease: is there cause for alarm? Pediatr Nephrol 2018; 33:2047-2055. [PMID: 29374316 DOI: 10.1007/s00467-017-3870-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 12/03/2017] [Accepted: 12/04/2017] [Indexed: 02/02/2023]
Abstract
Acute kidney injury (AKI) is characterized clinically as an abrupt decline in renal function marked by reduced excretion of waste products, disordered electrolytes, and disrupted fluid homeostasis. The recent development of a standardized AKI definition has transformed our understanding of AKI epidemiology and outcomes. We now know that in the short term, children with AKI experience greater morbidity and mortality; additionally, observational studies have established that chronic renal sequelae are far more common after AKI events than previously realized. Many of these studies suggest that patients who develop AKI are at greater risk for the subsequent development of chronic kidney disease (CKD). The goal of this review is to critically evaluate the data regarding the association between AKI and CKD in children. Additionally, we describe best practice approaches for future studies, including the use of consensus AKI criteria, the application of rigorous definitions for CKD and renal sequelae, and the inclusion of non-AKI comparator groups. Finally, based upon existing data, we suggest an archetypal approach to follow-up care for the AKI survivors who may be at greater CKD risk, including children with more severe AKI, those who endure repeated AKI episodes, patients who do not experience full recovery, and those with pre-existing CKD.
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Affiliation(s)
- Vaka K Sigurjonsdottir
- Department of Pediatrics, Division of Nephrology, Stanford University School of Medicine, 300 Pasteur Drive, Room G-306, Stanford, CA, USA
| | | | - Cherry Mammen
- Division of Paediatric Nephrology, Department of Paediatrics, British Columbia Children's Hospital, Vancouver, BC, Canada
| | - Scott M Sutherland
- Department of Pediatrics, Division of Nephrology, Stanford University School of Medicine, 300 Pasteur Drive, Room G-306, Stanford, CA, USA.
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87
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Shalaby MA, Sawan ZA, Nawawi E, Alsaedi S, Al-Wassia H, Kari JA. Incidence, risk factors, and outcome of neonatal acute kidney injury: a prospective cohort study. Pediatr Nephrol 2018; 33:1617-1624. [PMID: 29869723 DOI: 10.1007/s00467-018-3966-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 03/23/2018] [Accepted: 03/26/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is common in neonates admitted to the neonatal intensive care unit (NICU). AKI is associated with increased morbidity and mortality and a greater long-term risk of chronic kidney disease. OBJECTIVES To study the incidence and outcome of neonatal AKI in a single Saudi Arabian center, level 2\3 NICU. METHODS This single-center prospective cohort study included all infants who received level II or III NICU care during 2015 (January to December). We excluded infants who survived less than 48 h after admission, had evidence of congenital renal anomalies, or had insufficient data. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Both AKI and non-AKI neonates were prospectively followed up until NICU discharge. Outcomes studied included mortality and length of NICU stay. The results of adjusted risk analyses were expressed as relative risk (RR) with 95% confidence interval (95% CI). RESULTS The incidence of AKI (modified neonatal KDIGO stages) was 56% (120/214 patients). Compared with neonates without AKI, those with AKI had a lower birth weight (2202 ± 816 vs. 1570 ± 776 g; p < 0.001) and a lower gestational age (35 ± 3 vs. 32 ± 4 weeks; p < 0.001). After adjustment for potential confounders, only gestational age (RR, 4.8; 95% CI, 3-9) and perinatal depression (RR, 10; 95% CI, 2-46) were significantly associated with an increased risk of AKI. For infants with gestational age < 32 weeks, only the Clinical Risk Index for Babies (CRIB II) score was associated with an increased risk of AKI (RR, 1.9; 95% CI, 1-3). After adjustment for gestational age, AKI was significantly associated with mortality (RR, 5.4; 95% CI, 2-14), but not with the length of hospital stay (LOS) (p = 0.133). However, the AKI group had a significantly longer LOS (mean difference: 14 days; 95% CI, 5.5-23 days), and 33 patients (27.5%) with AKI were discharged with abnormally high serum creatinine levels (> 65 μmol/L). CONCLUSION AKI occurred in more than half of all NICU admissions, was associated with an increased risk of mortality, and had a higher incidence among smaller and sicker infants. Therefore, close monitoring of renal function during hospitalization and after discharge is warranted in such infants.
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Affiliation(s)
- Mohamed A Shalaby
- Pediatric Nephrology Center of Excellence, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Zinab A Sawan
- Department of Pediatrics, King Abdulaziz University, PO Box 80215, Jeddah, 21589, Kingdom of Saudi Arabia.
| | - Esraa Nawawi
- Department of Pediatrics, King Abdulaziz University, PO Box 80215, Jeddah, 21589, Kingdom of Saudi Arabia
| | - Saad Alsaedi
- Neonatal Intensive Care Unit, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Heidi Al-Wassia
- Neonatal Intensive Care Unit, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
| | - Jameela A Kari
- Pediatric Nephrology Center of Excellence, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
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89
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Cleper R, Shavit I, Blumenthal D, Reisman L, Pomeranz G, Haham A, Friedman S, Goldiner I, Mandel D. Neonatal acute kidney injury: recording rate, course, and outcome: one center experience. J Matern Fetal Neonatal Med 2018; 32:3379-3385. [DOI: 10.1080/14767058.2018.1463985] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Roxana Cleper
- Pediatric Nephrology Unit, Tel Aviv Sourasky Medical Center, Dana-Dwek Children’s Hospital, Tel Aviv, Israel
- Department of Neonatology, Tel Aviv Sourasky Medical Center, Dana-Dwek Hospital, Tel Aviv, Israel
| | - Itay Shavit
- Department of Neonatology, Tel Aviv Sourasky Medical Center, Dana-Dwek Hospital, Tel Aviv, Israel
| | - Danit Blumenthal
- Pediatric Nephrology Unit, Tel Aviv Sourasky Medical Center, Dana-Dwek Children’s Hospital, Tel Aviv, Israel
- Department of Neonatology, Tel Aviv Sourasky Medical Center, Dana-Dwek Hospital, Tel Aviv, Israel
| | - Lewis Reisman
- Pediatric Nephrology Unit, Tel Aviv Sourasky Medical Center, Dana-Dwek Children’s Hospital, Tel Aviv, Israel
| | - Galit Pomeranz
- Pediatric Nephrology Unit, Tel Aviv Sourasky Medical Center, Dana-Dwek Children’s Hospital, Tel Aviv, Israel
- Department of Neonatology, Tel Aviv Sourasky Medical Center, Dana-Dwek Hospital, Tel Aviv, Israel
| | - Alon Haham
- Department of Neonatology, Tel Aviv Sourasky Medical Center, Dana-Dwek Hospital, Tel Aviv, Israel
- Tel Aviv Sourasky Medical Center, Central Chemistry Laboratory, Tel Aviv, Israel
| | - Shiran Friedman
- Pediatric Nephrology Unit, Tel Aviv Sourasky Medical Center, Dana-Dwek Children’s Hospital, Tel Aviv, Israel
| | - Ilana Goldiner
- Department of Neonatology, Tel Aviv Sourasky Medical Center, Dana-Dwek Hospital, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dror Mandel
- Department of Neonatology, Tel Aviv Sourasky Medical Center, Dana-Dwek Hospital, Tel Aviv, Israel
- Tel Aviv Sourasky Medical Center, Central Chemistry Laboratory, Tel Aviv, Israel
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90
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Zhang R, Dong WB. [Monitoring of kidney injury in preterm infants]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:332-337. [PMID: 29658461 PMCID: PMC7390029 DOI: 10.7499/j.issn.1008-8830.2018.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 02/12/2018] [Indexed: 06/08/2023]
Abstract
Acute kidney injury (AKI) is a common complication in the neonatal intensive care unit that causes a high mortality of preterm infants and various chronic kidney diseases in adulthood. Preterm infants have immature development of the kidneys at birth. The kidneys continue to develop within a specific time window after birth. However, due to various factors during pregnancy and after birth, preterm infants tend to develop AKI. At present, serum creatinine and urine volume are used for the assessment of kidney injury, and their early sensitivity and specificity have attracted increasing attention. In recent years, various new biomarkers have been identified for early recognition of AKI. This article reviews the features, risk factors, renal function assessment, and prevention/treatment of AKI of preterm infants, in order to provide a reference for improving early diagnosis and treatment of AKI in preterm infants and long-term quality of life.
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Affiliation(s)
- Rong Zhang
- Department of Neonatology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan 646000, China.
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91
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Abstract
Acute kidney injury (AKI) occurs in approximately 30% of all infants hospitalized in the neonatal intensive care unit. About 40% of very low-birth-weight infants develop AKI, with an estimated mortality rate of 50% to 80%. Very low-birth-weight survivors have twice the risk of developing chronic renal disease later in life compared with their term counterparts. Current diagnostic modalities for AKI include serum creatinine and urine output; however, recent studies suggest that these measures are imprecise, as they may not change until 25% to 50% of renal function is lost. Urinary biomarkers may more accurately identify infants at risk for early AKI development. The purpose of this review is to discuss current research findings related to neonatal AKI risk factors, provide an overview of short- and long-term outcomes, describe innovative diagnostic approaches, and identify future research direction needed to improve prediction and intervention strategies associated with renal impairment.
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92
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Zappitelli M, Ambalavanan N, Askenazi DJ, Moxey-Mims MM, Kimmel PL, Star RA, Abitbol CL, Brophy PD, Hidalgo G, Hanna M, Morgan CM, Raju TN, Ray P, Reyes-Bou Z, Roushdi A, Goldstein SL. Developing a neonatal acute kidney injury research definition: a report from the NIDDK neonatal AKI workshop. Pediatr Res 2017; 82:569-573. [PMID: 28604760 PMCID: PMC9673450 DOI: 10.1038/pr.2017.136] [Citation(s) in RCA: 137] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 02/26/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Michael Zappitelli
- Division of Nephrology, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Québec, Canada
| | - Namasivayam Ambalavanan
- Departments of Pediatrics, Molecular and Cellular Pathology, and Cell, Developmental, and Integrative Biology, University of Alabama at Birmingham, Birmingham, Alabama
| | - David J. Askenazi
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - Marva M. Moxey-Mims
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Paul L. Kimmel
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Robert A. Star
- Division of Kidney Urologic and Hematologic Diseases, National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland
| | - Carolyn L. Abitbol
- Department of Pediatric Nephrology, Holtz Children’s Hospital, University of Miami Miller School of Medicine, Miami, Florida
| | - Patrick D. Brophy
- Department of Pediatrics, University of Iowa Children’s Hospital, Pediatric Nephrology, Dialysis and Transplantation, University of Iowa Healthcare, University of Iowa Health System, Iowa City, Iowa
| | - Guillermo Hidalgo
- Department of Pediatrics, East Carolina University, East Carolina University School of Medicine, Greenville, North Carolina
| | - Mina Hanna
- Department of Pediatrics, University of Kentucky, Lexington, Kentucky
| | | | - Tonse N.K. Raju
- National Institute of Child Health and Human Development, National Institutes of Health, Pregnancy and Perinatology Branch, Bethesda, Maryland
| | - Patricio Ray
- Department of Nephrology, Main Hospital, Children’s National Health System, Washington, DC
| | - Zayhara Reyes-Bou
- Department of Pediatrics, University of Puerto Rico, Medical Sciences Campus, Neonatal Perinatal Medicine Section, San Juan, Puerto Rico
| | - Amani Roushdi
- Department of Pediatrics, Mackenzie Health Hospital, Richmond Hill, Ontario, Canada
| | - Stuart L. Goldstein
- Department of Pediatrics, Cincinnati Children’s Hospital and Medical Center, Cincinnati, USA
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Chang-Chien C, Chuang GT, Tsai IJ, Chiang BL, Yang YH. A large retrospective review of persistent proteinuria in children. J Formos Med Assoc 2017; 117:711-719. [PMID: 28943081 DOI: 10.1016/j.jfma.2017.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 08/13/2017] [Accepted: 09/05/2017] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Proteinuria is a common finding in children. It may be due to a benign cause, but it can also represent early renal injury. Of children with persistent proteinuria noted in mass urine screening programs, 35% have a urine protein level greater than 100 mg/dl and many of them are associated with many underlying renal diseases. The aim of this study was to identify the etiology and prognosis of persistent proteinuria in children. METHODS We collected data on urine protein from January 2011 to December 2016 in a tertiary medical center. During this 6-year period, 37,645 children received urinalysis, and 2.3% were found to have persistent proteinuria. We reviewed their medical charts for clinical diagnoses and renal function. According to the level of persistent proteinuria, we divided the children into three groups (mild, moderate, and severe). RESULTS Most clinical diagnoses in the mild persistent proteinuria group were not readily identifiable. In the moderate and severe groups, acute kidney injury was the leading cause of significant proteinuria, followed by systemic lupus erythematosus, steroid-sensitive nephrotic syndrome, and congenital urogenital tract anomalies. There were significant differences in the rate of chronic renal insufficiency among the three groups. Prematurity with extremely low birth weight was also a major factor associated with pediatric chronic renal insufficiency. CONCLUSION Assessing persistent proteinuria in children is important due to the diverse range of associated diseases or mortality.
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Affiliation(s)
- Chingying Chang-Chien
- Department of Pediatrics, National Taiwan University Children's Hospital, College of Medicine, National Taiwan University, No. 8 Chung-Shan South Rd., Taipei, 10061, Taiwan
| | - Gwo-Tsann Chuang
- Department of Pediatrics, National Taiwan University Children's Hospital, College of Medicine, National Taiwan University, No. 8 Chung-Shan South Rd., Taipei, 10061, Taiwan
| | - I-Jung Tsai
- Department of Pediatrics, National Taiwan University Children's Hospital, College of Medicine, National Taiwan University, No. 8 Chung-Shan South Rd., Taipei, 10061, Taiwan
| | - Bor-Luen Chiang
- Department of Medical Research, National Taiwan University Hospital, Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, No. 7 Chung-Shan South Rd., Taipei, 10061, Taiwan
| | - Yao-Hsu Yang
- Department of Pediatrics, National Taiwan University Children's Hospital, College of Medicine, National Taiwan University, No. 8 Chung-Shan South Rd., Taipei, 10061, Taiwan.
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Abstract
Acute kidney injury in children is associated with adverse outcomes, although much of our current understanding originates from studies in intensive care units. Holmes et al. used an automated acute kidney injury detection method to obtain epidemiologic data on pediatric acute kidney injury at a national level in outpatient, inpatient, and intensive care unit settings. We discuss the impact of these important results and the considerations needed with this approach.
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