Author Of 1 Presentation
NEONATAL ACUTE KIDNEY INJURY IN VERY LOW BIRTH WEIGHT PRETERM NEONATES USING NEONATAL KDIGO DEFINITION : UTILITY OF URINE OUTPUT.
Abstract
Background
Very low birth weight (VLBW) preterm neonates are at high risk of acute kidney injury (AKI). Urine output (UO) is part of the neonatal Kidney Disease Improving Global Outcomes (nKDIGO) definition, but datas are usually lacking.
Objectives
To identify risk factors and outcomes associated with neonatal AKI.
Methods
204 preterm neonates born before 30 weeks of gestational age (GA) were retrospectively enrolled between 2014 and 2018 in Geneva. AKI was defined according to the nKDIGO definition. Daily UO was recorded between day 1 and day 7. Exclusion criteria included death <24 hours and severe congenital malformations.
Results
Mean GA was 27.5 weeks and mean birth weight 1003 grams. AKI occurred in 59/204 (28.9%): 44 at stage I, 11 at stade II and 4 at stage III. Fifty percents of AKI were diagnosed exclusively on UO criteria, 32% on creatinine variation and 18% on both cumulated criterias. Significant risk factors for neonatal AKI included Apgar below 5 at 5 minutes, significant patent ductus arteriosus, necrotizing enterocolitis, late onset sepsis, exposure to dopamine, indomethacin, vancomycin and treatment with gentamycin ≥ 5 days. Infants with AKI had higher mortality compared to those without AKI (OR: 4.7 [1.45-16.55], p:0.003), a higher rate of moderate to severe bronchopulmonary dysplasia (OR: 2.5 [1.12-5.6], p:0.016) and a longer respiratory support (45.5 days [2-172] vs 33 days [0-342] p:0.022). Neurological outcome was not significantly impaired in case of AKI.
Conclusion
Neonatal AKI is common in VLBW preterm neonates and is associated with poor outcomes. Measuring urine output is highly relevant in this population.