急性肾损伤会损害极低出生体重儿的产后肾脏适应性，并增加其发病率和死亡率。
Acute Kidney Injury Impairs Postnatal Renal Adaptation and Increases Morbidity and Mortality in Very Low-Birth-Weight Infants.
作者信息
Srinivasan Nishant, Schwartz Alan, John Eunice, Price Ross, Amin Sachin
机构信息
Department of Pediatrics, University of Illinois, Chicago, Illinois.
Department of Medical Education, University of Illinois, Chicago, Illinois.
出版信息
Am J Perinatol. 2018 Jan;35(1):39-47. doi: 10.1055/s-0037-1604470. Epub 2017 Aug 2.
OBJECTIVE
This study aims to estimate the impact of acute kidney injury (AKI) on postnatal renal adaptation, morbidity, and mortality in very low-birth-weight (VLBW) infants.
DESIGN
We conducted a retrospective study of 457 VLBW infants admitted to a tertiary level neonatal intensive care unit (NICU) between July 2009 and April 2015. We compared patient characteristics, risk factors, serum creatinine trends, and adverse outcomes in infants with and without AKI using multivariate logistic regression analysis.
RESULTS
Incidence of AKI was 19.5%. On multivariate analysis, postnatal risk factors such as patent ductus arteriosus and vancomycin use were significantly associated with AKI. Infants with AKI had significantly higher mortality; 25/89 (28%) versus 15/368 (4%) ( < 0.001). Among survivors with AKI, bronchopulmonary dysplasia (BPD) was more prevalent (52.8 vs. 23.9%, < 0.001), serum creatinine remained elevated for a longer duration and median length of stay extended by 38 days.
CONCLUSION
Presence of AKI was associated with impaired postnatal renal adaptation, BPD, significantly longer stay in the NICU and higher mortality.
目的
本研究旨在评估急性肾损伤（AKI）对极低出生体重（VLBW）婴儿出生后肾脏适应、发病率和死亡率的影响。
设计
我们对2009年7月至2015年4月期间入住三级新生儿重症监护病房（NICU）的457例VLBW婴儿进行了一项回顾性研究。我们使用多因素逻辑回归分析比较了有无AKI婴儿的患者特征、危险因素、血清肌酐趋势和不良结局。
结果
AKI的发生率为19.5%。多因素分析显示，出生后诸如动脉导管未闭和使用万古霉素等危险因素与AKI显著相关。患有AKI的婴儿死亡率显著更高；25/89（28%）对比15/368（4%）（P<0.001）。在AKI存活者中，支气管肺发育不良（BPD）更为普遍（52.8%对23.9%，P<0.001），血清肌酐升高持续时间更长，中位住院时间延长38天。
结论
AKI的存在与出生后肾脏适应受损、BPD、在NICU停留时间显著延长以及死亡率升高有关。
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