Department of Pediatrics, Neonatology Subdivision, Acıbadem University School of Medicine, İstanbul, Turkey.
Department of Pediatrics, Pediatric Nephrology Subdivision, Acıbadem University School of Medicine, İstanbul, Turkey.
Pediatr Nephrol. 2021 Jul;36(7):1923-1929. doi: 10.1007/s00467-020-04890-z. Epub 2021 Jan 25.
Acute kidney injury (AKI) is a common complication of congenital heart diseases (CHDs) after cardiac surgery. This study aimed to define the frequency and critical course, risk factors and short-term outcomes of AKI in postoperative CHD neonates.
Postoperatively followed term CHD newborn infants were enrolled in the study. Infants with congenital anomalies of the urinary tract and other major congenital anomalies were excluded. Neonatal modified KDIGO criteria were used to assess AKI.
A total of 199 postoperatively followed newborn infants were included in the study. Acute kidney injury was detected in 71 (35.6%) patients. Of these patients, 24 (33.8%) were in stage 1, 14 (19.7%) in stage 2, and 33 (46.5%) in stage 3. Acute kidney injury occurred within the first week (median 1 day [IQR 1-2 days]) of cardiac surgery in 93% of the patients. The duration of invasive respiratory support and extracorporeal membrane oxygenation (ECMO) and mortality were significantly higher in stage 3 patients. Higher vasoactive-inotropic score (OR, 1.02; 95% CI, 1.0-1.04; p = 0.008) and receiving ECMO (OR, 7.9; 95% CI, 2.6-24.4; p = 0.001) were associated with risk for the development of AKI. The mortality rate was 52.1% in the AKI (+) patients, and having AKI (OR 7.1; 95% CI, 3.5-14.18) was significantly associated with mortality.
Acute kidney injury, a common early complication after critical neonatal CHD cardiac surgery, is associated with increased morbidity and mortality. Stage 3 AKI is associated with significantly higher mortality rates.
急性肾损伤（AKI）是心脏手术后先天性心脏病（CHD）的常见并发症。本研究旨在确定心脏手术后 CHD 新生儿 AKI 的频率、关键病程、危险因素和短期结局。
术后随访的 CHD 新生儿被纳入研究。排除患有先天性尿路畸形和其他主要先天性异常的婴儿。使用新生儿改良 KDIGO 标准评估 AKI。
共有 199 名术后随访的新生儿被纳入研究。71 名（35.6%）患者检测到急性肾损伤。其中，24 名（33.8%）处于 1 期，14 名（19.7%）处于 2 期，33 名（46.5%）处于 3 期。93%的患者 AKI 发生在心脏手术后的第一周（中位数 1 天[IQR 1-2 天]）。3 期患者的有创性呼吸支持和体外膜氧合（ECMO）时间以及死亡率显著更高。较高的血管活性-正性肌力评分（OR，1.02；95%CI，1.0-1.04；p=0.008）和 ECMO 治疗（OR，7.9；95%CI，2.6-24.4；p=0.001）与 AKI 发展风险相关。AKI（+）患者的死亡率为 52.1%，AKI（OR 7.1；95%CI，3.5-14.18）与死亡率显著相关。
急性肾损伤是危重新生儿 CHD 心脏手术后的常见早期并发症，与发病率和死亡率增加相关。3 期 AKI 与显著更高的死亡率相关。
