Department of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
Department of Pediatrics & Communicable Disease, Division of Pediatric Nephrology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
Pediatr Nephrol. 2018 Mar;33(3):503-510. doi: 10.1007/s00467-017-3809-y. Epub 2017 Oct 5.
Morbidity and mortality with necrotizing enterocolitis (NEC) remains a significant challenge. Acute kidney injury (AKI) has been shown to worsen survival in critically ill neonates. To our knowledge, this study is the first to evaluate the prevalence of AKI and its impact on outcomes in neonatal NEC.
We carried out a single-center retrospective chart review of all neonates treated for NEC between 2003 and 2015 (N = 181). AKI is defined as a rise in serum creatinine (SCr) from a previous trough according to neonatal modified KDIGO criteria (stage 1 = SCr rise 0.3 mg/dL or SCr 150 < 200%, stage 2 = SCr rise 200 < 300%, stage 3 = SCr rise ≥300%, SCr 2.5 mg/dL or dialysis). Primary outcome was in-hospital mortality and secondary outcomes were hospital length of stay (LOS) and need for and type of surgery.
Acute kidney injury occurred in 98 neonates (54%), with 39 stage 1 (22%), 31 stage 2 (18%), and 28 stage 3 (16%), including 5 requiring dialysis. Non-AKI and AKI groups were not statistically different in age, weight, Bell's NEC criteria, and medication exposure (vasopressors, vancomycin, gentamicin, or diuretic). Neonates with AKI had higher mortality (44% vs 25.6%, p = 0.008) and a higher chance of death (HR 2.4, CI 1.2-4.8, p = 0.009), but the effect on LOS on survivors did not reach statistical significance (79 days, interquartile range [IQR] 30-104 vs 54 days, IQR 30-92, p = 0.09). Overall, 48 (27.9%) patients required surgical intervention.
This study shows that AKI not only occurs in over half of patients with NEC, but that it is also associated with more than a two-fold higher mortality, highlighting the importance of early recognition and potentially early intervention for AKI.
坏死性小肠结肠炎（NEC）的发病率和死亡率仍然是一个重大挑战。急性肾损伤（AKI）已被证明会使危重新生儿的存活率恶化。据我们所知，这项研究首次评估了 AKI 的患病率及其对新生儿 NEC 结局的影响。
我们对 2003 年至 2015 年间接受 NEC 治疗的所有新生儿进行了单中心回顾性图表审查（N=181）。AKI 定义为根据新生儿改良 KDIGO 标准（第 1 期：血清肌酐（SCr）从先前的低谷上升 0.3mg/dL 或 SCr 150%<200%；第 2 期：SCr 上升 200%<300%；第 3 期：SCr 上升≥300%，SCr 2.5mg/dL 或透析）。主要结局为院内死亡率，次要结局为住院时间（LOS）和手术的需求和类型。
98 名新生儿（54%）发生 AKI，其中 39 例为第 1 期（22%），31 例为第 2 期（18%），28 例为第 3 期（16%），其中 5 例需要透析。非 AKI 组和 AKI 组在年龄、体重、NEC 贝尔标准和药物暴露（血管加压素、万古霉素、庆大霉素或利尿剂）方面无统计学差异。AKI 新生儿死亡率更高（44%比 25.6%，p=0.008），死亡风险更高（HR 2.4，CI 1.2-4.8，p=0.009），但对幸存者 LOS 的影响无统计学意义（79 天，四分位距 [IQR] 30-104 比 54 天，IQR 30-92，p=0.09）。总体而言，48 名（27.9%）患者需要手术干预。
本研究表明，AKI 不仅发生在超过一半的 NEC 患者中，而且与死亡率增加两倍以上相关，这凸显了早期识别和潜在早期干预 AKI 的重要性。
