Pediatric Nephrology Center of Excellence, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia.
Department of Pediatrics, King Abdulaziz University, PO Box 80215, Jeddah, 21589, Kingdom of Saudi Arabia.
Pediatr Nephrol. 2018 Sep;33(9):1617-1624. doi: 10.1007/s00467-018-3966-7. Epub 2018 Jun 5.
Acute kidney injury (AKI) is common in neonates admitted to the neonatal intensive care unit (NICU). AKI is associated with increased morbidity and mortality and a greater long-term risk of chronic kidney disease.
To study the incidence and outcome of neonatal AKI in a single Saudi Arabian center, level 2\3 NICU.
This single-center prospective cohort study included all infants who received level II or III NICU care during 2015 (January to December). We excluded infants who survived less than 48 h after admission, had evidence of congenital renal anomalies, or had insufficient data. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Both AKI and non-AKI neonates were prospectively followed up until NICU discharge. Outcomes studied included mortality and length of NICU stay. The results of adjusted risk analyses were expressed as relative risk (RR) with 95% confidence interval (95% CI).
The incidence of AKI (modified neonatal KDIGO stages) was 56% (120/214 patients). Compared with neonates without AKI, those with AKI had a lower birth weight (2202 ± 816 vs. 1570 ± 776 g; p < 0.001) and a lower gestational age (35 ± 3 vs. 32 ± 4 weeks; p < 0.001). After adjustment for potential confounders, only gestational age (RR, 4.8; 95% CI, 3-9) and perinatal depression (RR, 10; 95% CI, 2-46) were significantly associated with an increased risk of AKI. For infants with gestational age < 32 weeks, only the Clinical Risk Index for Babies (CRIB II) score was associated with an increased risk of AKI (RR, 1.9; 95% CI, 1-3). After adjustment for gestational age, AKI was significantly associated with mortality (RR, 5.4; 95% CI, 2-14), but not with the length of hospital stay (LOS) (p = 0.133). However, the AKI group had a significantly longer LOS (mean difference: 14 days; 95% CI, 5.5-23 days), and 33 patients (27.5%) with AKI were discharged with abnormally high serum creatinine levels (> 65 μmol/L).
AKI occurred in more than half of all NICU admissions, was associated with an increased risk of mortality, and had a higher incidence among smaller and sicker infants. Therefore, close monitoring of renal function during hospitalization and after discharge is warranted in such infants.
急性肾损伤（AKI）在新生儿重症监护病房（NICU）收治的新生儿中很常见。AKI 与发病率和死亡率增加以及长期慢性肾脏病风险增加有关。
研究单一沙特阿拉伯中心、2/3 级 NICU 中新生儿 AKI 的发生率和结局。
这项单中心前瞻性队列研究纳入了 2015 年（1 月至 12 月）期间接受 2 级或 3 级 NICU 护理的所有婴儿。我们排除了入院后生存时间少于 48 小时、有先天性肾脏异常证据或数据不足的婴儿。AKI 根据肾脏病：改善全球预后（KDIGO）标准定义。AKI 和非 AKI 新生儿均前瞻性随访至 NICU 出院。研究的结局包括死亡率和 NICU 住院时间。调整风险分析的结果表示为相对风险（RR）和 95%置信区间（95%CI）。
AKI（改良新生儿 KDIGO 分期）的发生率为 56%（120/214 例患者）。与无 AKI 的新生儿相比，AKI 新生儿的出生体重较低（2202±816 比 1570±776 g；p<0.001），胎龄较小（35±3 比 32±4 周；p<0.001）。在调整潜在混杂因素后，仅胎龄（RR，4.8；95%CI，3-9）和围产期抑郁（RR，10；95%CI，2-46）与 AKI 风险增加显著相关。对于胎龄<32 周的婴儿，只有临床婴儿风险指数（CRIB II）评分与 AKI 风险增加相关（RR，1.9；95%CI，1-3）。在调整胎龄后，AKI 与死亡率显著相关（RR，5.4；95%CI，2-14），但与住院时间（LOS）无关（p=0.133）。然而，AKI 组的 LOS 明显更长（平均差异：14 天；95%CI，5.5-23 天），33 名（27.5%）AKI 患者出院时血清肌酐水平异常升高（>65 μmol/L）。
AKI 在所有 NICU 入院患者中超过一半，与死亡率增加有关，并且在较小和病情较重的婴儿中发病率更高。因此，需要对这些婴儿住院期间和出院后进行密切的肾功能监测。
