先天性膈疝新生儿急性肾损伤的危险因素。
Risk factors for acute kidney injury in neonates with congenital diaphragmatic hernia.
机构信息
Department of Pediatrics, Section of Neonatology, Children's Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA.
出版信息
J Perinatol. 2021 Aug;41(8):1901-1909. doi: 10.1038/s41372-021-01119-1. Epub 2021 Jun 12.
OBJECTIVE
To examine incidence of acute kidney injury (AKI), antenatal and postnatal predictors, and impact of AKI on outcomes in infants with congenital diaphragmatic hernia (CDH).
STUDY DESIGN
Single center retrospective study of 90 CDH infants from 2009-2017. Baseline characteristics, CDH severity, possible AKI predictors, and clinical outcomes were compared between infants with and without AKI.
RESULT
In total, 38% of infants developed AKI, 44% stage 1, 29% stage 2, 27% stage 3. Lower antenatal lung volumes and liver herniation were associated with AKI. Extracorporeal life support (ECLS), diuretics, abdominal closure surgery, hypotension, and elevated plasma free hemoglobin were associated with AKI. Overall survival was 79%, 47% with AKI, and 35% with AKI on ECLS. AKI is associated with increased mechanical ventilation duration and length of stay.
CONCLUSION
AKI is common among CDH infants and associated with adverse outcomes. Standardized care bundles addressing AKI risk factors may reduce AKI incidence and severity.
目的
探讨先天性膈疝（CDH）患儿急性肾损伤（AKI）的发生率、产前和产后预测因素，以及 AKI 对患儿结局的影响。
研究设计
这是一项 2009 年至 2017 年间单中心回顾性研究，共纳入 90 例 CDH 患儿。比较 AKI 患儿和非 AKI 患儿的基线特征、CDH 严重程度、可能的 AKI 预测因素和临床结局。
结果
共有 38%的患儿发生 AKI，其中 44%为 1 期，29%为 2 期，27%为 3 期。产前肺容积较小和肝疝出与 AKI 相关。体外生命支持（ECLS）、利尿剂、腹部闭合手术、低血压和游离血红蛋白升高与 AKI 相关。总体生存率为 79%，AKI 患儿为 47%，ECLS 治疗的 AKI 患儿为 35%。AKI 与机械通气时间延长和住院时间延长相关。
结论
AKI 在 CDH 患儿中较为常见，与不良结局相关。针对 AKI 危险因素的标准化护理方案可能会降低 AKI 的发生率和严重程度。
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