Incidence, Outcome, and Associated Clinical Features Early A
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Critically ill neonates are at high risk of kidney injury, mainly in the first days of life. Acute kidney injury (AKI) may be underdiagnosed due to lack of a uniform definition. A Study was conducted to describe incidence, etiology, and outcome of neonates developing AKI within the first week after birth in a cohort of NICU-admitted neonates. Renal function at discharge in infants with early AKI was assessed.

AKI was defined as an absolute serum Cr (sCr) value above 1.5 mg/dL (132 mol/L) after the first 24 h or as stage 2–3 of the NIDDK neonatal definition. Clinical data and outcomes were collected from medical records and retrospectively analyzed. A total of 9,376 infants were admitted to the NICU of whom 139 were diagnosed with AKI during the first week after birth.

--In 72 term infants, the most common etiology was perinatal asphyxia (72.2%), followed by congenital kidney and urinary tract malformations (CAKUT) (8.3%), congenital heart disease (6.9%), and sepsis (2.8%).

--Associated conditions in 67 preterm infants were medical treatment of a hemodynamic significant PDA (27.2%), ­CAKUT (21%), and birth asphyxia (19.4%).

--Among preterm neonates and neonates with perinatal asphyxia, AKI was mainly diagnosed by the sCr more than 1.5 mg/dL criterion.

--Renal function at discharge improved in 76 neonates with AKI associated with acquired conditions. Neonates with stage 3 AKI showed increased sCr values at discharge.

--Half of these were caused by congenital kidney malformations and evolved into chronic kidney disease (CKD) later in life.

--Neurodevelopmental outcome (NDO) at 2 years was favorable in 93% of surviving neonates with detailed follow-up.

Finally, AKI was observed in 1.5% of infants admitted to a level III NICU during the first week after birth. Renal function had increased in most neonates with acquired AKI at discharge, but not in infants with stage 3 AKI.