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Deng Z, Tang J, Fang C, Zhang BH. Development and validation of a diagnostic prediction model for severe periventricular-intraventricular hemorrhage in newborns: insights from a retrospective analysis utilizing the MIMIC-III database. J Pediatr (Rio J) 2024; 100:327-334. [PMID: 38342483 PMCID: PMC11065675 DOI: 10.1016/j.jped.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 02/13/2024] Open
Abstract
OBJECTIVE Periventricular-intraventricular hemorrhage is the most common type of intracranial bleeding in newborns, especially in the first 3 days after birth. Severe periventricular-intraventricular hemorrhage is considered a progression from mild periventricular-intraventricular hemorrhage and is often closely associated with severe neurological sequelae. However, no specific indicators are available to predict the progression from mild to severe periventricular-intraventricular in early admission. This study aims to establish an early diagnostic prediction model for severe PIVH. METHOD This study was a retrospective cohort study with data collected from the MIMIC-III (v1.4) database. Laboratory and clinical data collected within the first 24 h of NICU admission have been used as variables for both univariate and multivariate logistic regression analyses to construct a nomogram-based early prediction model for severe periventricular-intraventricular hemorrhage and subsequently validated. RESULTS A predictive model was established and represented by a nomogram, it comprised three variables: output, lowest platelet count and use of vasoactive drugs within 24 h of NICU admission. The model's predictive performance showed by the calculated area under the curve was 0.792, indicating good discriminatory power. The calibration plot demonstrated good calibration between observed and predicted outcomes, and the Hosmer-Lemeshow test showed high consistency (p = 0.990). Internal validation showed the calculated area under a curve of 0.788. CONCLUSIONS This severe PIVH predictive model, established by three easily obtainable indicators within the NICU, demonstrated good predictive ability. It offered a more user-friendly and convenient option for neonatologists.
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Affiliation(s)
- Zhiyue Deng
- Department of Neonatology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiaxin Tang
- Department of Neonatology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Chengzhi Fang
- Department of Neonatology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Bing-Hong Zhang
- Department of Neonatology, Renmin Hospital of Wuhan University, Wuhan, China.
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2
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Vincent K, Rutledge A, Laney Z, Newman JC, Selewski DT, Steflik HJ. Recurrent neonatal acute kidney injury: incidence, predictors, and outcomes in the neonatal intensive care unit. J Perinatol 2024; 44:428-433. [PMID: 37932405 DOI: 10.1038/s41372-023-01800-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/26/2023] [Accepted: 10/06/2023] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Determine recurrent neonatal acute kidney injury (rAKI) incidence, risk factors, and associated outcomes. STUDY DESIGN Single-center retrospective cohort of neonates admitted to the NICU 1/1/20-6/30/21. Comparisons were made between those with no AKI, single AKI episode (sAKI), and rAKI. Multivariable linear and logistic regression models were used to assess associations between rAKI and length of mechanical ventilation (LMV), length of hospitalization stay (LOS), mortality, and hypertension (HTN) at discharge. RESULTS The incidence of AKI in the cohort of 869 infants was 19%: 705 (81%) no AKI, 100 (12%) sAKI, 64 (7%) rAKI. Both sAKI and rAKI were independently associated with longer LMV and LOS. sAKI was independently associated with almost 4x higher odds of mortality than rAKI. CONCLUSION In this single center cohort of neonates, sAKI independently predicts mortality, however rAKI is independently associated with increased LMV and LOS suggesting rAKI is clinically important and warrants further study.
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Affiliation(s)
- Katherine Vincent
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.
| | - Austin Rutledge
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Zegilor Laney
- Department of Pediatrics, Cincinnati Children's Medical Center, Cincinnati, OH, USA
| | - Jill C Newman
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - David T Selewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Heidi J Steflik
- Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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3
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Starr MC, Gilley SP, See EJ, Slagle C, Soranno DE. Adults are just big kids: pediatric considerations for adult critical care nephrology. Curr Opin Crit Care 2023; 29:580-586. [PMID: 37861193 DOI: 10.1097/mcc.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
PURPOSE OF REVIEW In recent years, there has been growing attention to pediatric kidney health, especially pediatric acute kidney injury (AKI). However, there has been limited focus on the role of pediatric AKI on adult kidney health, specifically considerations for the critical care physician. RECENT FINDINGS We summarize what is known in the field of pediatric AKI to inform adult medical care including factors throughout the early life course, including perinatal, neonatal, and pediatric exposures that impact survivor care later in adulthood. SUMMARY The number of pediatric AKI survivors continues to increase, leading to a higher burden of chronic kidney disease and other long-term co-morbidities later in life. Adult medical providers should consider pediatric history and illnesses to inform the care they provide. Such knowledge may help internists, nephrologists, and intensivists alike to improve risk stratification, including a lower threshold for monitoring for AKI and kidney dysfunction in their patients.
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Affiliation(s)
- Michelle C Starr
- Indiana University School of Medicine, Department of Pediatrics, Pediatric Nephrology
- Child Health Service Research Division, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Stephanie P Gilley
- University of Colorado School of Medicine, Department of Pediatrics, Section of Nutrition, Aurora, Colorado, USA
| | - Emily J See
- Royal Melbourne Hospital, Departments of Intensive Care and Nephrology, Melbourne, VIC, Australia
| | - Cara Slagle
- Cincinnati Children's Hospital Medical Center, University of Cincinnati, Department of Pediatrics, Cincinnati, Ohio
| | - Danielle E Soranno
- Indiana University School of Medicine, Department of Pediatrics, Pediatric Nephrology
- Purdue University, Weldon School of Bioengineering, Department of Bioengineering, West Lafayette, Indiana, USA
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Acute Kidney Injury in Very Low Birth Weight Infants: A Major Morbidity and Mortality Risk Factor. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020242. [PMID: 36832371 PMCID: PMC9955621 DOI: 10.3390/children10020242] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/13/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Very low birth weight (VLBW) infants are at high risk of developing acute kidney injury (AKI), presumably secondary to low kidney reserves, stressful postnatal events, and drug exposures. Our study aimed to identify the prevalence, risk factors, and outcomes associated with AKI in VLBW infants. STUDY DESIGN Records of all VLBW infants admitted to two medical campuses between January 2019 and June 2020 were retrospectively reviewed. AKI was classified using the modified KDIGO definition to include only serum creatinine. Risk factors and composite outcomes were compared between infants with and without AKI. We evaluated the main predictors of AKI and death with forward stepwise regression analysis. RESULTS 152 VLBW infants were enrolled. 21% of them developed AKI. Based on the multivariable analysis, the most significant predictors of AKI were the use of vasopressors, patent ductus arteriosus, and bloodstream infection. AKI had a strong and independent association with neonatal mortality. CONCLUSIONS AKI is common in VLBW infants and is a significant risk factor for mortality. Efforts to prevent AKI are necessary to prevent its harmful effects.
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Hu J, Ananth D, Sethi SK, Taliwal N, Govindan S, Raina R. Neonatal AKI: An update. J Neonatal Perinatal Med 2023; 16:361-373. [PMID: 37718869 DOI: 10.3233/npm-230120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Neonatal acute kidney injury (AKI) is a common complication, especially in the neonatal intensive care unit, that is associated with long term consequences and poor outcomes. Early detection and treatment is critical. Currently, neonatal AKI is defined with urinary markers and serum creatinine, with limitations on early detection and individual treatment. There have been numerous biomarkers and risk factor scores that have been studied for their ability to predict neonatal AKI. To move towards personalized medicine, neonatal AKI must be categorized into phenotypes and subphenotypes that fully encapsulate the diverse causes and specific treatments. This review aims to advance our understanding of neonatal AKI detection through the use of biomarkers, subphenotypes, and phenotypes to move towards personalized treatment strategies.
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Affiliation(s)
- J Hu
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - D Ananth
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - S K Sethi
- Pediatric Nephrology & Pediatric Kidney Transplantation, Kidney and Urology Institute, Medanta, The Medicity Hospital, Gurgaon, India
| | - N Taliwal
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
| | - S Govindan
- Department of Pediatric Nephrology, Dr. Mehta's Hospitals, Chetpet and Vellapanchavadi, Chennai, India
| | - R Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA
- Department of Nephrology, Akron Children's Hospital, Akron, OH, USA
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Association between acute kidney injury and brain injury on term-equivalent age brain magnetic resonance imaging in very preterm infants. Pediatr Nephrol 2022; 37:3235-3242. [PMID: 35359177 DOI: 10.1007/s00467-022-05534-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND This study aimed to investigate the relationship between acute kidney injury (AKI) in the first 2 weeks of life and brain injury on term-equivalent age magnetic resonance imaging in very preterm infants. METHODS We included 116 infants with a birth weight of < 1500 g who were born at the King Saud Medical City at ≤ 32 gestational weeks. They were admitted to the neonatal intensive care unit and underwent term-equivalent age and pre-discharge brain magnetic resonance imaging. A negative binomial with generalized linear models and a robust variance estimator (Huber-White) was applied for univariate relative risk analysis. The Kidokoro score was then used to determine the effect of AKI on brain morphology and growth at term-equivalent age. RESULTS Sixty-eight (64.2%) infants had developed an AKI in the first 2 weeks of life. AKI was significantly associated with cerebellum signal abnormalities, cerebellar volume reduction, and a high total cerebellum score (P = 0.04, P < 0.001, P < 0.001, respectively). CONCLUSIONS AKI in the first 2 weeks of life is associated with brain insult, especially in the cerebellum. More well-designed studies are required to investigate the association and impact of AKI on the central nervous system. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Acute kidney injury in premature and low birth weight neonates: a systematic review and meta-analysis. Pediatr Nephrol 2022; 37:275-287. [PMID: 34529137 DOI: 10.1007/s00467-021-05251-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) is common and it is associated with poor clinical outcomes in premature and low birth weight neonates. This systematic review and meta-analysis was performed to summarize the literature and evaluate the prevalence, risk factors, and mortality of premature and low birth weight neonates with AKI. METHODS A systematic search in PubMed, Embase, and the Cochrane Library was performed. Studies on the prevalence, risk factors, diagnosis, and outcomes of acute kidney injury in preterm neonates and neonates with low birth weight were included and analyzed. RESULTS Fifty articles of 10,744 patients were included in this study. The overall rate of AKI from the pooled results of all patients was 25% (95% CI 20-30%) with heterogeneity among studies (I2 = 97%; P < 0.01). Patients with AKI had significantly higher rate of mortality than patients without AKI (odds ratio (OR) = 7.13; 95% CI 5.91-8.60; P < 0.01). CONCLUSIONS AKI was prevalent and was associated with high mortality rate among preterm and low birth weight neonates.
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Starr MC, Charlton JR, Guillet R, Reidy K, Tipple TE, Jetton JG, Kent AL, Abitbol CL, Ambalavanan N, Mhanna MJ, Askenazi DJ, Selewski DT, Harer MW. Advances in Neonatal Acute Kidney Injury. Pediatrics 2021; 148:peds.2021-051220. [PMID: 34599008 DOI: 10.1542/peds.2021-051220] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 01/14/2023] Open
Abstract
In this state-of-the-art review, we highlight the major advances over the last 5 years in neonatal acute kidney injury (AKI). Large multicenter studies reveal that neonatal AKI is common and independently associated with increased morbidity and mortality. The natural course of neonatal AKI, along with the risk factors, mitigation strategies, and the role of AKI on short- and long-term outcomes, is becoming clearer. Specific progress has been made in identifying potential preventive strategies for AKI, such as the use of caffeine in premature neonates, theophylline in neonates with hypoxic-ischemic encephalopathy, and nephrotoxic medication monitoring programs. New evidence highlights the importance of the kidney in "crosstalk" between other organs and how AKI likely plays a critical role in other organ development and injury, such as intraventricular hemorrhage and lung disease. New technology has resulted in advancement in prevention and improvements in the current management in neonates with severe AKI. With specific continuous renal replacement therapy machines designed for neonates, this therapy is now available and is being used with increasing frequency in NICUs. Moving forward, biomarkers, such as urinary neutrophil gelatinase-associated lipocalin, and other new technologies, such as monitoring of renal tissue oxygenation and nephron counting, will likely play an increased role in identification of AKI and those most vulnerable for chronic kidney disease. Future research needs to be focused on determining the optimal follow-up strategy for neonates with a history of AKI to detect chronic kidney disease.
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Affiliation(s)
- Michelle C Starr
- Division of Pediatric Nephrology, Department of Pediatrics, School of Medicine, Indiana University, Indianapolis, Indiana
| | - Jennifer R Charlton
- Division of Nephrology, Department of Pediatrics, University of Virginia, Charlottesville, Virginia
| | - Ronnie Guillet
- Division of Neonatology, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York
| | - Kimberly Reidy
- Division of Pediatric Nephrology, Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Trent E Tipple
- Section of Neonatal-Perinatal Medicine, Department of Pediatrics, College of Medicine, The University of Oklahoma, Oklahoma City, Oklahoma
| | - Jennifer G Jetton
- Division of Nephrology, Dialysis, and Transplantation, Stead Family Department of Pediatrics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa
| | - Alison L Kent
- Division of Neonatology, Department of Pediatrics, Golisano Children's Hospital, University of Rochester Medical Center, Rochester, New York.,College of Health and Medicine, The Australian National University, Canberra, Australia Capitol Territory, Australia
| | - Carolyn L Abitbol
- Division of Pediatric Nephrology, Department of Pediatrics, Miller School of Medicine, University of Miami and Holtz Children's Hospital, Miami, Florida
| | | | - Maroun J Mhanna
- Department of Pediatrics, Louisiana State University Shreveport, Shreveport, Louisiana
| | - David J Askenazi
- Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama
| | - David T Selewski
- Division of Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina
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9
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Starr MC, Menon S. Neonatal acute kidney injury: a case-based approach. Pediatr Nephrol 2021; 36:3607-3619. [PMID: 33594463 DOI: 10.1007/s00467-021-04977-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 12/19/2022]
Abstract
Neonatal acute kidney injury (AKI) is increasingly recognized as a common complication in critically ill neonates. Over the last 5-10 years, there have been significant advancements which have improved our understanding and ability to care for neonates with kidney disease. A variety of factors contribute to an increased risk of AKI in neonates, including decreased nephron mass and immature tubular function. Multiple factors complicate the diagnosis of AKI including low glomerular filtration rate at birth and challenges with serum creatinine as a marker of kidney function in newborns. AKI in neonates is often multifactorial, but the cause can be identified with careful diagnostic evaluation. The best approach to treatment in such patients may include diuretic therapies or kidney support therapy. Data for long-term outcomes are limited but suggest an increased risk of chronic kidney disease (CKD) and hypertension in these infants. We use a case-based approach throughout this review to illustrate these concepts and highlight important evidence gaps in the diagnosis and management of neonatal AKI.
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Affiliation(s)
- Michelle C Starr
- Division of Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Shina Menon
- Department of Pediatrics, University of Washington, Seattle, WA, USA
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10
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Matsumura S, Masutani S, Oshima A, Kanai M, Namba F, Ishiguro A, Kabe K. Is ibuprofen superior to indomethacin for patent ductus arteriosus in Japanese preterm infants? Pediatr Int 2021; 63:929-934. [PMID: 33274573 DOI: 10.1111/ped.14566] [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] [Received: 06/09/2020] [Revised: 10/16/2020] [Accepted: 11/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Many clinical trials have indicated that ibuprofen (IBU) has similar effects to indomethacin (IND) on the closure of patent ductus arteriosus (PDA) with fewer adverse effects. Owing to the scarce evidence on IBU use in Japan because of its recent approval we performed this observational study to compare the efficacy and safety of IBU with the efficiency and safety of IND. METHODS We included infants (gestational age < 30 weeks) with hemodynamically significant PDA under a prophylactic IND protocol for intraventricular hemorrhage who were treated with either IND (n = 30) or IBU (n = 30). We compared a PDA closing effect, changes in ultrasonography findings, and adverse effects between the groups. RESULTS There was no significant difference in the rates of PDA closure in the first treatment course (IND vs IBU: 46.7% vs 50.0%, P = 0.796) and surgical closure (IND vs IBU: 20.0% vs 20.0%, P = 1.000) between the groups. Both groups showed significant oliguria (IND vs IBU: 30.0% vs 23.3%, P = 0.559) and increased serum creatinine levels after treatment. However, an increase in serum creatinine level by >0.3 mg/dL, a criterion for acute kidney injury, was less frequent in the IBU group (35.7%) compared with that in the IND group (84.2%, P = 0.004). There were no significant differences in echocardiographic changes and jaundice and hypoglycemia incidence rates between the groups. CONCLUSIONS Except for an increase in serum creatinine levels by >0.3 mg/dL, which was less frequent with IBU, IBU had similar efficacy and safety as IND for preterm PDA. Ibuprofen and IND should be cautiously administered.
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Affiliation(s)
- Shun Matsumura
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Satoshi Masutani
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Ayumi Oshima
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Masayo Kanai
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Fumihiko Namba
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Akio Ishiguro
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Kazuhiko Kabe
- Department of Pediatrics, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
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Al-Mouqdad MM, Huseynova R, Khalil TM, Asfour YS, Asfour SS. Relationship between intraventricular hemorrhage and acute kidney injury in premature infants and its effect on neonatal mortality. Sci Rep 2021; 11:13262. [PMID: 34168258 PMCID: PMC8225823 DOI: 10.1038/s41598-021-92746-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/03/2021] [Indexed: 11/10/2022] Open
Abstract
Intraventricular hemorrhage (IVH) and acute kidney injury (AKI) are important neonatal morbidities in premature infants. This study aimed to investigate the relationship between IVH and AKI in premature infants and whether this association affects the incidence of neonatal mortality. Infants [gestational age (GA) ≤ 32 weeks; birth weight (BW) < 1500 g] were retrospectively evaluated in a large tertiary neonatal intensive care unit. Of 710 premature infants, 268 (37.7%) developed AKI. Infants with IVH were more likely to have AKI than those without IVH. Infants with severe IVH had a higher incidence of AKI than infants with mild IVH. Infants younger than 28 weeks with IVH were more likely to have AKI than those without IVH. An association between IVH grades and AKI stages was observed in the overall study population, in infants with GA < 28 weeks, and in infants with GA between 28 and 32 weeks. Mortality was increased 1.5 times in infants with IVH and AKI compared with that in infants with IVH but without AKI. Furthermore, mortality was increased in infants with IVH and AKI compared with infants without IVH or AKI. This study shows a direct relationship between the severity of IVH and the degree of AKI; both IVH and AKI increase the incidence of neonatal mortality.
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Affiliation(s)
- Mountasser M Al-Mouqdad
- Neonatal Intensive Care, Hospital of Paediatrics, King Saud Medical City, Al Imam Abdul Aziz Ibn Muhammad Ibn Saud, Riyadh, 12746, Saudi Arabia.
| | - Roya Huseynova
- Neonatal Intensive Care, Hospital of Paediatrics, King Saud Medical City, Al Imam Abdul Aziz Ibn Muhammad Ibn Saud, Riyadh, 12746, Saudi Arabia
| | - Thanaa M Khalil
- Obstetric and Gynecology Department, Maternity Hospital, King Saud Medical City, Riyadh, Saudi Arabia
| | - Yasmeen S Asfour
- Obstetric and Gynecology Department, Family Care Hospital, Riyadh, Saudi Arabia
| | - Suzan S Asfour
- Clinical Pharmacy Department, Pharmaceutical Care Services, King Saud Medical City, Riyadh, Saudi Arabia
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Coggins SA, Laskin B, Harris MC, Grundmeier RW, Passarella M, McKenna KJ, Srinivasan L. Acute Kidney Injury Associated with Late-Onset Neonatal Sepsis: A Matched Cohort Study. J Pediatr 2021; 231:185-192.e4. [PMID: 33340552 DOI: 10.1016/j.jpeds.2020.12.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/16/2020] [Accepted: 12/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To determine incidence and severity of acute kidney injury (AKI) within 7 days of sepsis evaluation and to assess AKI duration and the association between AKI and 30-day mortality. STUDY DESIGN Retrospective, matched cohort study in a single-center level IV neonatal intensive care unit. Eligible infants underwent sepsis evaluations at ≥72 hours of age during calendar years 2013-2018. Exposed infants (cases) were those with culture-proven sepsis and antimicrobial duration ≥5 days. Nonexposed infants (controls) were matched 1:1 to exposed infants based on gestational and corrected gestational age, and had negative sepsis evaluations with antibiotic durations <48 hours. AKI was defined by modified neonatal Kidney Disease Improving Global Outcomes criteria. Statistical analysis included Mann-Whitney and χ2 tests, multivariable logistic regression, and Kaplan-Meier time-to-event analysis. RESULTS Among 203 episodes of late-onset sepsis, 40 (20%) developed AKI within 7 days after evaluation, and among 193 episodes with negative cultures, 16 (8%) resulted in AKI (P = .001). Episodes of sepsis also led to greater AKI severity, compared with nonseptic episodes (P = .007). The timing of AKI onset and AKI duration did not differ between groups. Sepsis was associated with increased odds of developing AKI (aOR, 3.0; 95% CI, 1.5-6.2; P = .002). AKI was associated with increased 30-day mortality (aOR, 4.5; 95% CI, 1.3-15.6; P = .017). CONCLUSIONS Infants with late-onset sepsis had increased odds of AKI and greater AKI severity within 7 days of sepsis evaluation, compared with age-matched infants without sepsis. AKI was independently associated with increased 30-day mortality. Strategies to mitigate AKI in critically ill neonates with sepsis may improve outcomes.
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Affiliation(s)
- Sarah A Coggins
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Benjamin Laskin
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Mary Catherine Harris
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Robert W Grundmeier
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Molly Passarella
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Perinatal and Pediatric Health Disparities Research, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Kristin J McKenna
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Lakshmi Srinivasan
- Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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13
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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: 3] [Impact Index Per Article: 0.8] [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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Acute kidney injury, fluid balance and risks of intraventricular hemorrhage in premature infants. J Perinatol 2020; 40:1296-1300. [PMID: 32066840 DOI: 10.1038/s41372-020-0613-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 01/14/2020] [Accepted: 02/04/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Evaluate association between fluid balance and intraventricular hemorrhage (IVH). STUDY DESIGN Retrospective review of infants <30 weeks gestation admitted to Kentucky Children's Hospital Neonatal Intensive Care Unit. RESULTS Infants with acute kidney injury (AKI) had a 2.4-fold increased risk of IVH (OR 2.38, 95% CI 1.46-3.87) and a 3.5-fold increased risk of severe IVH (OR 3.45, 95% CI 1.98-6.04). Infants above birthweight on day 4 had a 1.9-fold increased risk of IVH (OR 1.86, 95% CI 1.05-3.27) and a 2.0-fold increased risk of severe IVH (OR 1.96, 95% CI 1.03-3.74). When controlling for confounding factors, infants with AKI or above birthweight on day 4 had a 4.6-fold (aOR 4.60, 95% CI 1.80-11.78) and 3.0-fold (aOR 2.96, 95% CI 1.01-8.65) increased risk of severe IVH, respectively. CONCLUSION Infants with AKI during the first week of life had a higher association of severe IVH even after controlling for confounding factors.
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Pham JT, Jacobson JL, Ohler KH, Kraus DM, Calip GS. Evaluation of the Risk Factors for Acute Kidney Injury in Neonates Exposed to Antenatal Indomethacin. J Pediatr Pharmacol Ther 2020; 25:606-616. [PMID: 33041715 PMCID: PMC7541026 DOI: 10.5863/1551-6776-25.7.606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Evidence is limited about important maternal and neonatal risk factors that affect neonatal renal function. The incidence of acute kidney injury (AKI) and identification of associated risk factors in neonates exposed to antenatal indomethacin was studied. METHODS A retrospective cohort of neonates exposed to antenatal indomethacin within 1 week of delivery was analyzed for development of AKI up to 15 days of life. Adjusted hazard ratios (HRs) and 95% CIs for AKI risk were calculated in time-dependent Cox proportional hazards models. RESULTS Among 143 neonates with mean gestational age of 28.3 ± 2.4 weeks, AKI occurred in 62 (43.3%), lasting a median duration of 144 hours (IQR, 72-216 hours). Neonates with AKI had greater exposure to postnatal NSAIDs (48.4% vs 9.9%, p < 0.001) and inotropes (37.1% vs 3.7%, p < 0.001) compared with neonates without AKI. In multivariable-adjusted models, increased AKI risk was observed with antenatal indomethacin doses received within 24 to 48 hours (HR, 1.6; 95% CI, 1.28-1.94; p = 0.036) and <24 hours (HR, 2.33; 95% CI, 1.17-4.64; p = 0.016) prior to delivery. Further, postnatal NSAIDs (HR, 2.8; 95% CI, 1.03-7.61; p = 0.044), patent ductus arteriosus (HR, 4.04; 95% CI, 1.27-12.89; p = 0.018), and bloodstream infection (HR, 3.01; 95% CI, 1.37-6.60; p = 0.006) were associated significantly with increased risk of AKI following antenatal indomethacin. Neonates with AKI experienced more bloodstream infection, severe intraventricular hemorrhage, patent ductus arteriosus, respiratory distress syndrome, and longer hospitalization. CONCLUSIONS Extended risk of AKI with antenatal indomethacin deserves clinical attention among this population at an already increased AKI risk.
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Stoops C, Boohaker L, Sims B, Griffin R, Selewski DT, Askenazi D. The Association of Intraventricular Hemorrhage and Acute Kidney Injury in Premature Infants from the Assessment of the Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) Study. Neonatology 2019; 116:321-330. [PMID: 31461717 PMCID: PMC6881521 DOI: 10.1159/000501708] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 06/17/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) and intraventricular hemorrhage (IVH) are common in premature infants. We previously demonstrated that infants with AKI have a higher hazards ratio to develop grade ≥2 IVH when controlling for confounders. However, that single-center study was unable to show an overall association. OBJECTIVES To test the hypothesis that infants diagnosed with AKI have an increased risk of IVH independent of variables associated with both AKI and IVH, we performed a study on 825 infants from the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) study (a 24-center multinational retrospective cohort). METHOD A neonatal modified KDIGO definition of AKI was used based on serum creatinine (SCr) and/or urine output criteria. Baseline SCr was defined as the lowest previous value. IVH was diagnosed with head ultrasounds. RESULTS AKI was documented in 22.2% (183/825) of infants and IVH in 14.3% (118/825). Infants with AKI (n = 183) were more likely to have IVH (26.8%, 49/183) than those without AKI (n= 642) who had IVH (10.7%, 69/642, p < 0.0001). After controlling for 5-min Apgar score, vasopressor support within the first week of age, and gestational age, infants with AKI had 1.6 times higher adjusted odds to develop any grade IVH (95% CI 1.04-2.56). Furthermore, infants of gestational age of 22-28 weeks had 1.9 times higher adjusted odds to develop IVH (OR 1.87, 95% CI 1.08-3.23). CONCLUSIONS We present the first multicenter evaluation of the association between AKI and IVH in premature infants showing a significant independent association between AKI and IVH. Development of strategies to reduce AKI may also reduce IVH.
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Affiliation(s)
- Christine Stoops
- Department of Pediatrics, Division of Perinatal-Neonatal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA,
| | - Louis Boohaker
- Department of Pediatrics, Division of Pediatric Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brian Sims
- Department of Pediatrics, Division of Perinatal-Neonatal Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Russell Griffin
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David T Selewski
- Department of Pediatrics, Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina, USA
| | - David Askenazi
- Department of Pediatrics, Division of Pediatric Nephrology, Pediatric and Infant Center for Acute Nephrology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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18
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Harer MW, Askenazi DJ, Boohaker LJ, Carmody JB, Griffin RL, Guillet R, Selewski DT, Swanson JR, Charlton JR. Association Between Early Caffeine Citrate Administration and Risk of Acute Kidney Injury in Preterm Neonates: Results From the AWAKEN Study. JAMA Pediatr 2018; 172:e180322. [PMID: 29610830 PMCID: PMC6137530 DOI: 10.1001/jamapediatrics.2018.0322] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/31/2018] [Indexed: 12/11/2022]
Abstract
Importance Acute kidney injury (AKI) occurs commonly in preterm neonates and is associated with increased morbidity and mortality. Objectives To examine the association between caffeine citrate administration and AKI in preterm neonates in the first 7 days after birth and to test the hypothesis that caffeine administration would be associated with reduced incidence and severity of AKI. Design, Setting, and Participants This study was a secondary analysis of the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) study, a retrospective observational cohort that enrolled neonates born from January 1 to March 31, 2014. The dates of analysis were October 2016 to December 2017. The setting was an international, multicenter cohort study of neonates admitted to 24 participating level III or IV neonatal intensive care units. Participants met the original inclusion and exclusion criteria of the AWAKEN study. Additional exclusion criteria for this study included participants greater than or equal to 33 weeks' gestation at birth, admission after age 7 days, use of theophylline in the neonatal intensive care unit, or lack of data to define AKI. There were 675 preterm neonates available for analysis. Exposure Administration of caffeine in the first 7 days after birth. Main Outcomes and Measures The primary outcome was the incidence of AKI (based on the modified neonatal Kidney Disease: Improving Global Outcomes [KDIGO] definition) in the first 7 days after birth. The hypothesis that caffeine administration would be associated with reduced AKI incidence was formulated before data analysis. Results The study cohort (n = 675) was 55.4% (n = 374) male, with a mean (SD) gestational age of 28.9 (2.8) weeks and a mean (SD) birth weight of 1285 (477) g. Acute kidney injury occurred in 122 neonates (18.1%) in the first 7 days after birth. Acute kidney injury occurred less frequently among neonates who received caffeine than among those who did not (50 of 447 [11.2%] vs 72 of 228 [31.6%], P < .01). After multivariable adjustment, administration of caffeine remained associated with reduced odds of developing AKI (adjusted odds ratio, 0.20; 95% CI, 0.11-0.34), indicating that for every 4.3 neonates exposed to caffeine one case of AKI was prevented. Among neonates with early AKI, those receiving caffeine were less likely to develop stage 2 or 3 AKI (adjusted odds ratio, 0.20; 95% CI, 0.12-0.34). Conclusions and Relevance Caffeine administration in preterm neonates is associated with reduced incidence and severity of AKI. Further studies should focus on the timing and dosage of caffeine to optimize the prevention of AKI.
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Affiliation(s)
- Matthew W. Harer
- Division of Neonatology, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin–Madison
| | - David J. Askenazi
- Division of Nephrology, Department of Pediatrics, The University of Alabama at Birmingham
| | - Louis J. Boohaker
- Division of Nephrology, Department of Pediatrics, The University of Alabama at Birmingham
| | - J. Bryan Carmody
- Division of Nephrology, Department of Pediatrics, Eastern Virginia Medical School, Norfolk
| | - Russell L. Griffin
- Division of Nephrology, Department of Pediatrics, The University of Alabama at Birmingham
| | - Ronnie Guillet
- Division of Neonatology, Department of Pediatrics, Golisano Children’s Hospital, University of Rochester, Rochester, New York
| | - David T. Selewski
- Division of Nephrology, Department of Pediatrics, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor
| | - Jonathan R. Swanson
- Division of Neonatology, Department of Pediatrics, University of Virginia, Charlottesville
| | - Jennifer R. Charlton
- Division of Nephrology, Department of Pediatrics, University of Virginia, Charlottesville
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Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. THE LANCET CHILD & ADOLESCENT HEALTH 2017; 1:184-194. [PMID: 29732396 PMCID: PMC5933049 DOI: 10.1016/s2352-4642(17)30069-x] [Citation(s) in RCA: 404] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Background Single-center studies suggest that neonatal acute kidney injury (AKI)
is associated with poor outcomes. However, inferences regarding the
association between AKI, mortality, and hospital length of stay are limited
due to the small sample size of those studies. In order to determine whether
neonatal AKI is independently associated with increased mortality and longer
hospital stay, we analyzed the Assessment of Worldwide Acute Kidney
Epidemiology in Neonates (AWAKEN) database. Methods All neonates admitted to 24 participating neonatal intensive care
units from four countries (Australia, Canada, India, United States) between
January 1 and March 31, 2014, were screened. Of 4273 neonates screened, 2022
(47·3%) met study criteria. Exclusion criteria included: no
intravenous fluids ≥48 hours, admission ≥14 days of life,
congenital heart disease requiring surgical repair at <7 days of life,
lethal chromosomal anomaly, death within 48 hours, inability to determine
AKI status or severe congenital kidney abnormalities. AKI was defined using
a standardized definition —i.e., serum creatinine rise of
≥0.3 mg/dL (26.5 mcmol/L) or ≥50% from previous
lowest value, and/or if urine output was <1 mL/kg/h on postnatal days 2
to 7. Findings Incidence of AKI was 605/2022 (29·9%). Rates varied
by gestational age groups (i.e., ≥22 to <29 weeks
=47·9%; ≥29 to <36 weeks
=18·3%; and ≥36 weeks
=36·7%). Even after adjusting for multiple potential
confounding factors, infants with AKI had higher mortality compared to those
without AKI [(59/605 (9·7%) vs. 20/1417
(1·4%); p< 0.001; adjusted OR=4·6
(95% CI=2·5–8·3);
p=<0·0001], and longer hospital stay
[adjusted parameter estimate 8·8 days (95%
CI=6·1–11·5);
p<0·0001]. Interpretation Neonatal AKI is a common and independent risk factor for mortality
and longer hospital stay. These data suggest that neonates may be impacted
by AKI in a manner similar to pediatric and adult patients. Funding US National Institutes of Health, University of Alabama at
Birmingham, Cincinnati Children’s, University of New Mexico.
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Minuth W. Reading First Coordinates from the Nephrogenic Zone in Human Fetal Kidney. Nephron Clin Pract 2017; 138:137-146. [DOI: 10.1159/000481441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 09/11/2017] [Indexed: 01/15/2023] Open
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Risk of nonsteroidal anti-inflammatory drug-associated renal dysfunction among neonates diagnosed with patent ductus arteriosus and treated with gentamicin. J Perinatol 2017; 37:1093-1102. [PMID: 28594394 DOI: 10.1038/jp.2017.80] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/03/2017] [Accepted: 05/04/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate the risk of nonsteroidal anti-inflammatory drug (NSAID) therapy-associated acute kidney injury (AKI) among neonates diagnosed with patent ductus arteriosus (PDA) who are treated with gentamicin. STUDY DESIGN Multicenter retrospective observational study of patients ⩽44 postmenstrual weeks of age diagnosed with PDA who received gentamicin during hospitalization between January 2006 and December 2014. Patients with and without NSAID exposure were matched on covariates associated with AKI and NSAID therapy. The primary end point, AKI, was defined according to Kidney Disease Improving Global Outcomes neonatal criteria. RESULTS The rate of AKI for the entire cohort (n=594) was 12% (n=71). Among neonates receiving NSAIDS, 14.8% (n=44) experienced an AKI as compared to 9.1% (n=27) for those who were not exposed (relative risk, 1.6; 95% confidence interval, 1.0 to 2.6). Therefore, the attributable risk of NSAID use was 5.7% (95% confidence interval, 0.5 to 11.0). CONCLUSION Among neonates with PDA and receiving gentamicin, NSAID therapy increases the risk of AKI by about 6%.
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