Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, China.
Department of Neonatology, West China Second Hospital, Sichuan University, Chengdu, China.
Pediatr Nephrol. 2020 Jul;35(7):1341-1346. doi: 10.1007/s00467-020-04532-4. Epub 2020 Mar 30.
Acute kidney injury (AKI) is common and associated with poor outcomes in critically ill neonates. The objective of this study was to study the incidence, risk factors, and clinical outcomes of AKI in neonates receiving non-cardiac surgery.
We performed a single-center retrospective study between January 2017 and December 2018 of neonates who had received abdominal and thoracic surgical procedures. AKI was defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Patient information, clinical data, and outcomes were collected and analyzed. Logistic regression was used to analyze risk factors of AKI and association between AKI and mortality.
Fifty-four (33.8%) of 160 patients developed AKI after surgical procedures. Compared with neonates without AKI, neonates with AKI had higher mortality rate (18.5% VS 5.7%, p = 0.022), lower gestational age (30.5 weeks, interquartile range [IQR] 28-33.5, VS 34.5 weeks, IQR 33-37.5, p = 0.035), higher rates of very low birth weight (33.3% VS 17.0%, p = 0.019), longer duration of mechanical ventilation (0.5 days, IQR 0-1.5, VS 0 days, IQR 0-1, p = 0.043) and higher rates of sepsis (35.2% VS 19.8%, p = 0.034). Risk factors of AKI included gestational age under 32 weeks (OR 4.8, 95% CI 1.8-12.6; p = 0.001), sepsis (OR 4.3, 95% CI 1.7-11.3; p = 0.003), operation time longer than 120 min (OR 2.7, 95% CI 1.1-6.6; p = 0.024), and diagnosis of necrotizing enterocolitis (OR 3.5, 95% CI 1.3-9.1; p = 0.011). AKI after surgery was significantly associated with mortality (OR 4.3, 95% CI 1.1-16.9; p = 0.036).
AKI is common and associated with poor outcomes in surgical neonates. Early recognition and intervention of AKI in these patients are important.
急性肾损伤（AKI）在危重新生儿中很常见，且与不良预后相关。本研究旨在研究接受非心脏手术的新生儿 AKI 的发生率、危险因素和临床结局。
我们进行了一项单中心回顾性研究，纳入了 2017 年 1 月至 2018 年 12 月间接受腹部和胸部手术的新生儿。AKI 采用肾脏病：改善全球预后（KDIGO）标准定义。收集并分析了患者信息、临床数据和结局。采用 logistic 回归分析 AKI 的危险因素以及 AKI 与死亡率之间的关联。
在 160 例手术患儿中，54 例（33.8%）发生 AKI。与无 AKI 的患儿相比，AKI 患儿的死亡率更高（18.5% VS 5.7%，p=0.022），胎龄更低（30.5 周，四分位距[IQR] 28-33.5，VS 34.5 周，IQR 33-37.5，p=0.035），极低出生体重儿比例更高（33.3% VS 17.0%，p=0.019），机械通气时间更长（0.5 天，IQR 0-1.5，VS 0 天，IQR 0-1，p=0.043），败血症发生率更高（35.2% VS 19.8%，p=0.034）。AKI 的危险因素包括胎龄小于 32 周（OR 4.8，95%CI 1.8-12.6；p=0.001）、败血症（OR 4.3，95%CI 1.7-11.3；p=0.003）、手术时间超过 120 分钟（OR 2.7，95%CI 1.1-6.6；p=0.024）和坏死性小肠结肠炎诊断（OR 3.5，95%CI 1.3-9.1；p=0.011）。术后 AKI 与死亡率显著相关（OR 4.3，95%CI 1.1-16.9；p=0.036）。
AKI 在接受手术的新生儿中很常见，且与不良预后相关。早期识别和干预这些患者的 AKI 非常重要。
