Department of Paediatrics and Child Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
PLoS One. 2020 Feb 13;15(2):e0229074. doi: 10.1371/journal.pone.0229074. eCollection 2020.
Neonatal acute kidney injury contributes to high mortality in developing countries. The burden of neonatal AKI is not known in Tanzania despite having high neonatal mortality. This study was conducted to determine the burden of AKI among critically ill neonates admitted at Muhimbili National Hospital.
This was a cross-sectional study conducted in the neonatal ward at the MNH. Eligible critically ill neonates were recruited consecutively between October 2017 and March 2018. Data was collected using a standardized structured questionnaire. Blood specimen was drawn to measure baseline creatinine at admission, 48th hour, 72nd hour and 14th day. Data was analysed using SPSS version 20.0 Univariate analysis was done using chi-square to determine the association between categorical variables and multivariate logistic regression was performed to determine predictors of AKI.
A total of 378 critically ill neonates were recruited, 31.5% had AKI and independent predictors of AKI were noted to be neonatal sepsis (aOR 2.237, 95%CI 1.3-3.6, P = 0.001), severe pneumonia (aOR3.0, 95%CI 1.0-9.3, P = 0.047) and use of gentamycin (aOR6.8, 95%CI 1.3-9.3, P = 0.02). Complete resolution of renal dysfunction at the fourteenth day was seen in 83.1% of the neonates while 16.9% had persistence of renal dysfunction. Ultrasound scan were performed among 105 participants with AKI revealed increased echogenicity, mild hydronephrosis and ectopic kidneys in 25 (23.8%), 4 (3.8%) and 2 (1.9%) respectively. In-hospital mortality was significantly higher among neonates with AKI (70.6%) as compared to those without (29.4%) p< 0.001.
AKI was noted in a third of critically ill neonates, with neonatal sepsis, severe pneumonia and use of gentamycin as independent predictors of AKI. Neonates who suffered AKI had twice as much mortality as compared to those without.
新生儿急性肾损伤是发展中国家高死亡率的原因之一。尽管坦桑尼亚的新生儿死亡率很高，但目前尚不清楚新生儿急性肾损伤的负担情况。本研究旨在确定穆希比利国家医院收治的危重新生儿急性肾损伤的负担。
这是一项横断面研究，在 MNH 的新生儿病房进行。2017 年 10 月至 2018 年 3 月连续招募符合条件的危重新生儿。使用标准化的结构化问卷收集数据。入院时、第 48 小时、第 72 小时和第 14 天采集血样测量基线肌酐。使用 SPSS 版本 20.0 进行数据分析。单变量分析采用卡方检验确定分类变量之间的关系，多变量 logistic 回归分析确定急性肾损伤的预测因素。
共招募 378 例危重新生儿，31.5%患有急性肾损伤，独立预测因素为新生儿败血症（比值比 2.237，95%可信区间 1.3-3.6，P=0.001）、严重肺炎（比值比 3.0，95%可信区间 1.0-9.3，P=0.047）和使用庆大霉素（比值比 6.8，95%可信区间 1.3-9.3，P=0.02）。第 14 天肾功能完全恢复的患儿占 83.1%，16.9%的患儿仍存在肾功能障碍。对 105 例急性肾损伤患儿进行超声检查，发现回声增强、轻度肾积水和异位肾分别为 25 例（23.8%）、4 例（3.8%）和 2 例（1.9%）。急性肾损伤患儿的院内死亡率明显高于无急性肾损伤患儿（70.6%比 29.4%，P<0.001）。
危重新生儿中 1/3患有急性肾损伤，新生儿败血症、严重肺炎和使用庆大霉素是急性肾损伤的独立预测因素。患有急性肾损伤的患儿死亡率是无急性肾损伤患儿的两倍。
