Incidence and Risk Factors of Early Onset Neonatal AKI
Copyright © 2019 by the American Society of Nephrology..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2019 |
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| Erschienen: |
2019 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:14 |
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| Enthalten in: |
Clinical journal of the American Society of Nephrology : CJASN - 14(2019), 2 vom: 07. Feb., Seite 184-195 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Charlton, Jennifer R [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 13.05.2020 Date Revised 07.05.2023 published: Print-Electronic ClinicalTrials.gov: NCT02443389 Citation Status MEDLINE |
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| doi: |
10.2215/CJN.03670318 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM303413263 |
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| 100 | 1 | |a Charlton, Jennifer R |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Incidence and Risk Factors of Early Onset Neonatal AKI |
| 264 | 1 | |c 2019 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Completed 13.05.2020 | ||
| 500 | |a Date Revised 07.05.2023 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a ClinicalTrials.gov: NCT02443389 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2019 by the American Society of Nephrology. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Multicenter Study | |
| 650 | 4 | |a Observational Study | |
| 650 | 4 | |a Research Support, N.I.H., Extramural | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Acute Kidney Injury | |
| 650 | 4 | |a Anti-Infective Agents | |
| 650 | 4 | |a Cesarean Section | |
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| 650 | 4 | |a Epinephrine | |
| 650 | 4 | |a Gestational Age | |
| 650 | 4 | |a Hyperbilirubinemia | |
| 650 | 4 | |a Incidence | |
| 650 | 4 | |a Infant | |
| 650 | 4 | |a Intensive Care Units | |
| 650 | 4 | |a Mating Factor | |
| 650 | 4 | |a Neonatal | |
| 650 | 4 | |a Newborn | |
| 650 | 4 | |a Pregnancy | |
| 650 | 4 | |a Retrospective Studies | |
| 650 | 4 | |a Vasoconstrictor Agents | |
| 650 | 4 | |a Xanthines | |
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| 650 | 4 | |a creatinine | |
| 650 | 4 | |a diuretics | |
| 650 | 4 | |a hospitalization | |
| 650 | 4 | |a methylxanthine | |
| 650 | 4 | |a neonatal kidney collaborative | |
| 650 | 4 | |a risk factors | |
| 700 | 1 | |a Boohaker, Louis |e verfasserin |4 aut | |
| 700 | 1 | |a Askenazi, David |e verfasserin |4 aut | |
| 700 | 1 | |a Brophy, Patrick D |e verfasserin |4 aut | |
| 700 | 1 | |a D'Angio, Carl |e verfasserin |4 aut | |
| 700 | 1 | |a Fuloria, Mamta |e verfasserin |4 aut | |
| 700 | 1 | |a Gien, Jason |e verfasserin |4 aut | |
| 700 | 1 | |a Griffin, Russell |e verfasserin |4 aut | |
| 700 | 1 | |a Hingorani, Sangeeta |e verfasserin |4 aut | |
| 700 | 1 | |a Ingraham, Susan |e verfasserin |4 aut | |
| 700 | 1 | |a Mian, Ayesa |e verfasserin |4 aut | |
| 700 | 1 | |a Ohls, Robin K |e verfasserin |4 aut | |
| 700 | 1 | |a Rastogi, Shantanu |e verfasserin |4 aut | |
| 700 | 1 | |a Rhee, Christopher J |e verfasserin |4 aut | |
| 700 | 1 | |a Revenis, Mary |e verfasserin |4 aut | |
| 700 | 1 | |a Sarkar, Subrata |e verfasserin |4 aut | |
| 700 | 1 | |a Smith, Alexandra |e verfasserin |4 aut | |
| 700 | 1 | |a Starr, Michelle |e verfasserin |4 aut | |
| 700 | 1 | |a Kent, Alison L |e verfasserin |4 aut | |
| 700 | 0 | |a Neonatal Kidney Collaborative |e verfasserin |4 aut | |
| 700 | 1 | |a Ambalavanan, Namasivayam |e investigator |4 oth | |
| 700 | 1 | |a Selewski, David T |e investigator |4 oth | |
| 700 | 1 | |a Fletcher, Jeffery |e investigator |4 oth | |
| 700 | 1 | |a Abitbol, Carolyn L |e investigator |4 oth | |
| 700 | 1 | |a Guillet, Ronnie |e investigator |4 oth | |
| 700 | 1 | |a DeFreitas, Marissa |e investigator |4 oth | |
| 700 | 1 | |a Duara, Shahnaz |e investigator |4 oth | |
| 700 | 1 | |a Rademacher, Erin |e investigator |4 oth | |
| 700 | 1 | |a Mhanna, Maroun J |e investigator |4 oth | |
| 700 | 1 | |a Raina, Rupesh |e investigator |4 oth | |
| 700 | 1 | |a Kumar, Deepak |e investigator |4 oth | |
| 700 | 1 | |a Arikan, Ayse Akcan |e investigator |4 oth | |
| 700 | 1 | |a Goldstein, Stuart L |e investigator |4 oth | |
| 700 | 1 | |a Nathan, Amy T |e investigator |4 oth | |
| 700 | 1 | |a Kupferman, Juan C |e investigator |4 oth | |
| 700 | 1 | |a Bhutada, Alok |e investigator |4 oth | |
| 700 | 1 | |a Bonachea, Elizabeth |e investigator |4 oth | |
| 700 | 1 | |a Mahan, John |e investigator |4 oth | |
| 700 | 1 | |a Nada, Arwa |e investigator |4 oth | |
| 700 | 1 | |a Jetton, Jennifer |e investigator |4 oth | |
| 700 | 1 | |a Colaizy, Tarah T |e investigator |4 oth | |
| 700 | 1 | |a Klein, Jonathan M |e investigator |4 oth | |
| 700 | 1 | |a Cole, F Sessions |e investigator |4 oth | |
| 700 | 1 | |a Davis, T Keefe |e investigator |4 oth | |
| 700 | 1 | |a Dower, Joshua |e investigator |4 oth | |
| 700 | 1 | |a Milner, Lawrence |e investigator |4 oth | |
| 700 | 1 | |a Reidy, Kimberly |e investigator |4 oth | |
| 700 | 1 | |a Kaskel, Frederick J |e investigator |4 oth | |
| 700 | 1 | |a Gist, Katja M |e investigator |4 oth | |
| 700 | 1 | |a Hanna, Mina H |e investigator |4 oth | |
| 700 | 1 | |a Wong, Craig S |e investigator |4 oth | |
| 700 | 1 | |a Joseph, Catherine |e investigator |4 oth | |
| 700 | 1 | |a DuPont, Tara |e investigator |4 oth | |
| 700 | 1 | |a Staples, Amy |e investigator |4 oth | |
| 700 | 1 | |a Khokhar, Surender |e investigator |4 oth | |
| 700 | 1 | |a Perazzo, Sofia |e investigator |4 oth | |
| 700 | 1 | |a Ray, Patricio E |e investigator |4 oth | |
| 700 | 1 | |a Mammen, Cherry |e investigator |4 oth | |
| 700 | 1 | |a Synnes, Anne |e investigator |4 oth | |
| 700 | 1 | |a Wintermark, Pia |e investigator |4 oth | |
| 700 | 1 | |a Zappitelli, Michael |e investigator |4 oth | |
| 700 | 1 | |a Sethi, Sidharth K |e investigator |4 oth | |
| 700 | 1 | |a Wazir, Sanjay |e investigator |4 oth | |
| 700 | 1 | |a Rohatgi, Smriti |e investigator |4 oth | |
| 700 | 1 | |a Soranno, Danielle E |e investigator |4 oth | |
| 700 | 1 | |a Chishti, Aftab S |e investigator |4 oth | |
| 700 | 1 | |a Woroniecki, Robert |e investigator |4 oth | |
| 700 | 1 | |a Swanson, Jonathan R |e investigator |4 oth | |
| 700 | 1 | |a Sridhar, Shanty |e investigator |4 oth | |
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