Graduate Institute of Clinical Medicine, College of Medicine, National Cheng-Kung University, Tainan, Taiwan.
Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Clin J Am Soc Nephrol. 2021 Aug;16(8):1169-1177. doi: 10.2215/CJN.19301220. Epub 2021 Aug 4.
Neonatal AKI in the preterm population is an under-recognized morbidity. Detecting AKI in preterm infants is important for their long-term kidney health. We aimed to examine the yearly trends of incidence and the related morbidities and care practices affecting the occurrence of neonatal AKI in extremely preterm (gestational age <29 weeks) and very preterm (gestational age 29-32 weeks) infants.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The trends and the related risk factors and care practices of AKI were examined in the extremely preterm (=434) and very preterm (=257) infants who were admitted within 14 days after birth from 2005 to 2018 to the University Hospital and had at least two serum creatinine measurements during hospitalization. We defined AKI as a serum creatinine rise of 0.3 mg/dl or more within 48 hours or a 1.5-fold increase within 7 days.
The extremely preterm group had a three-fold higher incidence of AKI (30% versus 10%) than the very preterm group. Among preterm infants with AKI, 92% had one episode of AKI, and 45% experienced stage 2 or 3 AKI; the mean duration of AKI was 12±9 days. Across the 14-year period, the crude incidence of AKI declined markedly from 56% to 17% in the extremely preterm group and from 23% to 6% in the very preterm group. After adjustment, a significant decline of AKI incidence was still observed in the extremely preterm group. The declining AKI in the extremely preterm infants was related to the trends of decreasing incidences of neonatal transfer, prolonged aminoglycoside exposure, prophylactic use of nonsteroidal anti-inflammatory drugs, and sepsis.
We observed a declining trend in the incidence of neonatal AKI among extremely preterm infants from 2005 to 2018, which may be related to improvement of care practices.
早产儿人群中的新生儿急性肾损伤（AKI）是一种未被充分认识的疾病。早期发现早产儿 AKI 对其肾脏健康具有重要意义。本研究旨在探讨极早产儿（胎龄＜29 周）和极早早产儿（胎龄 29-32 周）中 AKI 的发病率及相关并发症和治疗方法的年度变化趋势。
设计、地点、参与者和测量方法：该研究纳入了 2005 年至 2018 年期间在我院出生后 14 天内入院且住院期间至少进行了 2 次血清肌酐检测的 434 例极早产儿和 257 例极早早产儿，研究了 AKI 的趋势及其相关的危险因素和治疗方法。本研究中 AKI 定义为 48 小时内血清肌酐升高 0.3mg/dl 或以上，或 7 天内升高 1.5 倍以上。
极早产儿组 AKI 的发生率（30%）是极早早产儿组（10%）的 3 倍。在 AKI 的早产儿中，92%发生了 1 次 AKI，45%发生了 2 或 3 期 AKI；AKI 的平均持续时间为 12±9 天。在 14 年期间，极早产儿组 AKI 的粗发病率从 56%显著下降至 17%，极早早产儿组从 23%下降至 6%。经调整后，极早产儿组 AKI 的发病率仍呈显著下降趋势。极早产儿 AKI 的下降与新生儿转院率、氨基糖苷类药物暴露时间延长、预防性使用非甾体抗炎药和脓毒症发生率的变化趋势有关。
本研究发现，2005 年至 2018 年期间，极早产儿中新生儿 AKI 的发病率呈下降趋势，这可能与治疗方法的改进有关。
