Predictive factors and risk scoring system for acute kidney injury (aki) in sick neonates-a prospective cohort study.

Abstract

Neonatal AKI (acute kidney injury) is an underreported entity in sick neonates associated with significant morbidity and mortality. This was a prospective cohort study, to study the incidence, risk factors, and outcomes of AKI among sick neonates. We included sick inborn neonates admitted at a level III neonatal intensive care unit. Neonates with congenital anomalies and who died within 72 h of life were excluded. AKI was defined and categorized as per KDIGO guidelines. Two hundred and seventy-six neonates were enrolled over 1 year, of which 115 (42%) had AKI. The incidence of AKI was highest n = 27/38 (71%) among extremely preterm (< 28 weeks) infants. On Cox regression analysis, sepsis, invasive ventilation, acidosis, and perinatal asphyxia were significantly associated with AKI with a hazard ratio (95% CI) of 4 (1.21-13.42), 2.3 (1.32-4.03), 1.9 (1.13-3.36), and 1.5 (1.04-2.31), respectively. The risk prediction model, using the 4 predictors mentioned above, had good diagnostic accuracy (area under the curve, 83.6%) with a sensitivity and specificity of 77% and 80%, respectively. Infants with AKI have significantly higher mortality, compared to those who did not have AKI n = 45/115 (39%) vs. n = 5/161 (3%), p < 0.01.

Conclusions: Nearly half of sick neonates admitted to NICU have AKI, which is maximum in extremely preterm infants. Sepsis, invasive ventilation, acidosis, and perinatal asphyxia have good diagnostic accuracy in identifying neonates likely to develop AKI.

What is known: • Asphyxia, prematurity, sepsis, shock, hypotension, drugs, congenital heart diseases contribute to neonatal AKI.

What is new: • Our simple risk prediction model can be used in sick neonates to identify infants who are at risk for developing AKI.