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新生儿肾毒性药物暴露与早期急性肾损伤:来自 AWAKEN 研究的结果。

Neonatal nephrotoxic medication exposure and early acute kidney injury: results from the AWAKEN study.

机构信息

Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA.

Department of Pediatrics, University of Virginia, Charlottesville, VA, USA.

出版信息

J Perinatol. 2023 Aug;43(8):1029-1037. doi: 10.1038/s41372-023-01684-7. Epub 2023 Apr 26.

Abstract

BACKGROUND

We aimed to describe nephrotoxic medication exposure and investigate associations between exposure and acute kidney injury (AKI) in the neonatal intensive care unit during the first postnatal week.

DESIGN/METHODS: Secondary analysis of the AWAKEN cohort. We evaluated nephrotoxic medication exposure during the first postnatal week and associations with AKI using time-varying Cox proportional hazard regressions models. Nephrotoxic medication exposure categories were defined as: no nephrotoxic medication, nephrotoxic medications excluding aminoglycosides, aminoglycoside alone, and aminoglycoside and another nephrotoxic medication.

RESULTS

Of 2162 neonates, 1616 (74.7%) received ≥1 nephrotoxic medication. Aminoglycoside receipt was most common (72%). AKI developed in 211(9.8%) neonates and was associated with a nephrotoxic medication exposure (p < 0.01). Nephrotoxic medication exposures including a nephrotoxic medication excluding aminoglycoside (aHR 3.14, 95% CI 1.31-7.55) and aminoglycoside and  another nephrotoxic medication (aHR 4.79, 95% CI 2.19-10.50) were independently associated with AKI and severe AKI (stage 2/3), respectively.

CONCLUSIONS

Nephrotoxic medication exposure in critically ill infants is common during the first postnatal week. Specific nephrotoxic medication exposure, principally aminoglycosides with another nephrotoxic medication, are independently associated with early AKI.

摘要

背景

我们旨在描述新生儿重症监护病房(NICU)中新生儿在出生后第一周内的肾毒性药物暴露情况,并探讨其与急性肾损伤(AKI)之间的关系。

方法/设计:对 AWAKEN 队列进行二次分析。我们评估了出生后第一周内的肾毒性药物暴露情况,并使用时变 Cox 比例风险回归模型来研究其与 AKI 的相关性。肾毒性药物暴露类别定义为:无肾毒性药物、不包括氨基糖苷类的肾毒性药物、单独使用氨基糖苷类药物、以及同时使用氨基糖苷类和另一种肾毒性药物。

结果

在 2162 名新生儿中,有 1616 名(74.7%)接受了至少一种肾毒性药物。氨基糖苷类药物的使用最为常见(72%)。211 名(9.8%)新生儿发生 AKI,且与肾毒性药物暴露相关(p<0.01)。包括不包括氨基糖苷类药物的肾毒性药物暴露(aHR 3.14,95%CI 1.31-7.55)和同时使用氨基糖苷类和另一种肾毒性药物的暴露(aHR 4.79,95%CI 2.19-10.50)均与 AKI 和严重 AKI(2/3 期)独立相关。

结论

在出生后第一周,危重症婴儿的肾毒性药物暴露很常见。特定的肾毒性药物暴露,主要是氨基糖苷类药物与另一种肾毒性药物的联合暴露,与早期 AKI 独立相关。

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