Division of Pediatric Nephrology, Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, MLC 7022, Cincinnati, OH, 45229, USA.
Children's Hospital Association, Lenexa, KS, USA.
Pediatr Nephrol. 2023 Feb;38(2):583-591. doi: 10.1007/s00467-022-05626-x. Epub 2022 Jun 2.
Survival to hospital discharge in neonates born with kidney failure has not been previously described.
This was a retrospective, observational analysis of the Pediatric Health Information System (PHIS) database from 2005 to 2019. Primary outcome was survival at discharge; secondary outcomes were hospital and ICU length of stay (LOS). Univariate analysis was performed to describe the population by birth weight (BW) and characterize survival; multivariable generalized liner mixed modeling assuming a binomial distribution and logit link was performed to identify mortality risk factors.
Of 213 neonates born with kidney failure (median BW 2714 g; GA 35 weeks; 68% male), 4 (1.9%) did not receive dialysis or peritoneal dialysis (PD) catheter placement, 152 (72.9%) received PD only, 49 (23.4%) received PD plus extracorporeal dialysis (ECD), and 8 (3.4%) were treated with an undocumented dialysis modality. Median age at dialysis initiation was 7 days; median hospital LOS and ICU LOS were 84 and 69 days, respectively. One-hundred and sixty-two patients (76%) survived to discharge. Non-survivors (n = 51) were more likely to have received ECD and mechanical ventilation, and had a longer duration of mechanical ventilation. Every day of mechanical ventilation increased the mortality odds by 2% (n = 189; adjusted OR 1.02; 1.01, 1.03); in addition, the odds of mortality were 2 times higher in those who received ECD vs. only PD (adjusted OR 2.25; 1.04, 4.86).
Survival to initial hospital discharge occurs in the majority of neonates born with kidney failure. Predictors of increased mortality included longer duration of mechanical ventilation, as well as the requirement for ECD. A higher resolution version of the Graphical abstract is available as Supplementary information.
此前尚未报道过患有肾衰竭的新生儿在出院时的存活率。
这是一项对 2005 年至 2019 年期间儿科健康信息系统（PHIS）数据库进行的回顾性、观察性分析。主要结果是出院时的存活率；次要结果是住院和 ICU 住院时间（LOS）。采用单变量分析描述按出生体重（BW）划分的人群，并对生存率进行特征描述；采用假定二项分布和对数链接的多变量广义线性混合模型，对死亡率的危险因素进行识别。
在 213 名患有肾衰竭的新生儿中（中位 BW 为 2714g；GA 为 35 周；68%为男性），4 名（1.9%）未接受透析或腹膜透析（PD）置管，152 名（72.9%）仅接受 PD，49 名（23.4%）接受 PD 加体外透析（ECD），8 名（3.4%）接受未记录的透析方式治疗。开始透析的中位年龄为 7 天；中位住院 LOS 和 ICU LOS 分别为 84 天和 69 天。162 名（76%）患者存活至出院。未存活者（n=51）更可能接受 ECD 和机械通气，并且机械通气持续时间更长。机械通气每增加一天，死亡率的几率增加 2%（n=189；调整后的 OR 1.02；1.01，1.03）；此外，与仅接受 PD 相比，接受 ECD 的患者死亡几率增加 2 倍（调整后的 OR 2.25；1.04，4.86）。
大多数患有肾衰竭的新生儿在首次出院时可存活。增加死亡率的预测因素包括机械通气时间延长，以及需要 ECD。可提供图形摘要的更高分辨率版本作为补充信息。
