Division of Pediatric Nephrology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis.
Division of Child Health Service Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis.
JAMA Netw Open. 2024 Sep 3;7(9):e2435043. doi: 10.1001/jamanetworkopen.2024.35043.
Kidney disease is common in infants admitted to the neonatal intensive care unit (NICU). Despite the risk of chronic kidney disease (CKD) in infants discharged from the NICU, neither evidence- nor expert-based recommendations exist to guide clinical care after discharge.
To develop recommendations for risk stratification and kidney health monitoring among infants after discharge from the NICU.
At the National Institute of Health-supported Consensus Workshop to Address Kidney Health in Neonatal Intensive Care Unit Graduates meeting conducted in February 2024, a panel of 51 neonatal nephrology experts focused on 3 at-risk groups: (1) preterm infants, (2) critically ill infants with acute kidney injury (AKI), and (3) infants with critical cardiac disease. Using established modified Delphi processes, workgroups derived consensus recommendations.
In this modified Delphi consensus statement, the panel developed 10 consensus recommendations, identified gaps in knowledge, and prioritized areas of future research. Principal suggestions include risk stratification at time of hospital discharge, family and clinician education and counseling for subsequent kidney health follow-up, and blood pressure assessment as part of outpatient care.
Preterm infants, critically ill infants with AKI, and infants with critical cardiac disease are at increased risk of CKD. We recommend (1) risk assessment at the time of discharge, (2) clinician and family education, and (3) kidney health assessments based on the degree of risk. Future work should focus on improved risk stratification, identification of early kidney dysfunction, and development of interventions to improve long-term kidney health.
患有肾脏疾病的婴儿在新生儿重症监护病房（NICU）中很常见。尽管从 NICU 出院的婴儿有患慢性肾脏病（CKD）的风险，但目前既没有基于证据的推荐意见，也没有基于专家意见的推荐意见来指导出院后的临床护理。
为 NICU 出院后的婴儿制定风险分层和肾脏健康监测建议。
在 2024 年 2 月举行的由美国国立卫生研究院支持的解决新生儿重症监护病房毕业生肾脏健康问题共识研讨会会议上，一个由 51 名新生儿肾病学专家组成的小组专注于 3 个高危群体：（1）早产儿，（2）患有急性肾损伤（AKI）的危重症婴儿，以及（3）患有严重心脏疾病的婴儿。使用既定的改良 Delphi 流程，工作组得出了共识建议。
在这项改良 Delphi 共识声明中，专家组提出了 10 项共识建议，确定了知识差距，并确定了未来研究的优先领域。主要建议包括在出院时进行风险分层、为后续肾脏健康随访提供家庭和临床医生教育和咨询，以及将血压评估作为门诊护理的一部分。
早产儿、患有 AKI 的危重症婴儿和患有严重心脏疾病的婴儿患 CKD 的风险增加。我们建议（1）在出院时进行风险评估，（2）进行临床医生和家庭教育，以及（3）根据风险程度进行肾脏健康评估。未来的工作应重点关注改善风险分层、识别早期肾脏功能障碍以及制定改善长期肾脏健康的干预措施。
