Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
J Perinatol. 2024 Dec;44(12):1780-1785. doi: 10.1038/s41372-024-01922-6. Epub 2024 Mar 21.
Daily serum creatinine monitoring protocols for acute kidney injury (AKI) are invasive and may lead to surveillance resistance. We aimed to understand if use of urine neutrophil gelatinase-associated lipocalin (uNGAL) could increase high-risk nephrotoxic medication (NTMx) associated AKI screening adherence in neonates.
Statistical process control methods prior to and post implementation were trended. The primary outcome, screening adherence, was defined as either daily serum creatinine or uNGAL assessment through 2 days post high-risk NTMx exposure.
1291 monitoring days from the pre-implementation era (4/2020-6/2021) were compared to1377 monitoring days from the post-era (6/2021-10/2022). AKI screening adherence increased (81 to 92%) following implementation of optional uNGAL screening. Urine NGAL accounted for 35% of screening obtained. Use of uNGAL resulted in a 40% reduction in blood sampling for serum creatinine.
Incorporation of uNGAL as a complementary screening tool to serum creatinine demonstrated sustained increased AKI surveillance in our Baby NINJA monitoring program.
急性肾损伤 (AKI) 的每日血清肌酐监测方案具有侵入性，可能导致监测阻力。我们旨在了解尿液中性粒细胞明胶酶相关脂质运载蛋白 (uNGAL) 的使用是否可以提高新生儿高危肾毒性药物 (NTMx) 相关 AKI 筛查的依从性。
在实施前后使用统计过程控制方法进行趋势分析。主要结局是高危 NTMx 暴露后 2 天内进行每日血清肌酐或 uNGAL 评估，定义为筛查依从性。
与实施前的时代（2020 年 4 月至 6 月）相比，实施后（2021 年 6 月至 10 月）有 1291 天的监测数据，AKI 筛查的依从性从 81%增加到 92%。尿液 NGAL 占获得的筛查的 35%。使用 uNGAL 可将血清肌酐的采血量减少 40%。
将 uNGAL 作为血清肌酐的补充筛查工具纳入我们的 Baby NINJA 监测计划，证明 AKI 监测的持续增加。
