Tzvi-Behr Shimrit, Schlesinger Noam, Ben-Shalom Efrat, Frishberg Yaacov, Kasirer Yair
Division of Pediatric Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel.
Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Pediatr Nephrol. 2025 Jun;40(6):2091-2096. doi: 10.1007/s00467-025-06694-5. Epub 2025 Feb 3.
Acute kidney injury (AKI) in neonates is associated with increased morbidity and mortality, longer hospitalization, and a higher risk for future kidney damage. Caffeine treatment has reportedly been associated with a decreased AKI occurrence. However, previous studies lack uniformity regarding dosage and timing of administration. This study aimed to assess AKI incidence in very-low-birth-weight (VLBW) preterm infants (< 1500 g) treated with early high-dose caffeine and to identify risk factors associated with AKI.
A retrospective cohort study of VLBW preterm infants admitted to the Neonatal Intensive Care Unit at the Shaare Zedek Medical Center between January 1, 2017, and December 31, 2019. All VLBW infants born < 32 weeks of gestation were treated with a standardized caffeine regimen (20 mg/kg bolus; in the first hour of life, maintenance 10 mg/kg/day). Maternal and infant data including clinical, demographic, and laboratory measurements were retrieved from electronic medical records.
Of 311 VLBW infants admitted, all had adequate serum creatinine and urine output data. Of 301 patients included for analysis, 41 (14%) were diagnosed with AKI, while only 12/301 (4%) were diagnosed during the first week of life. Sixteen infants (5%) had > 1 AKI episode. Seven (7/41, 17%) had AKI stage 1 and seventeen infants (17/41, 42%) had stages 2 and 3. In univariate analysis, sepsis, patent ductus arteriosus, necrotizing enterocolitis (NEC), and hemodynamic instability during the first week of life were more prevalent in the AKI group. Infants with AKI were born with lower birth weights, at earlier gestational weeks, and had lower APGAR and higher CRIB II scores. NEC was the only significant risk factor associated with AKI in multivariate analysis. They also had a higher risk for bronchopulmonary dysplasia (BPD), longer hospitalization, and higher mortality rate.
The incidence of AKI in a cohort of VLBW infants universally treated early with caffeine was 14%, while only 4% had AKI during the first week. Infants with AKI had worse outcomes (BPD and mortality) and longer hospitalization.
新生儿急性肾损伤（AKI）与发病率和死亡率增加、住院时间延长以及未来肾脏损害风险较高相关。据报道，咖啡因治疗与AKI发生率降低有关。然而，先前的研究在给药剂量和时间方面缺乏一致性。本研究旨在评估早期高剂量咖啡因治疗的极低出生体重（VLBW）早产儿（<1500 g）的AKI发生率，并确定与AKI相关的危险因素。
对2017年1月1日至2019年12月31日期间入住沙雷兹德克医疗中心新生儿重症监护病房的VLBW早产儿进行回顾性队列研究。所有孕周<32周出生的VLBW婴儿均接受标准化咖啡因治疗方案（20 mg/kg静脉推注；出生后第一小时内，维持剂量10 mg/kg/天）。从电子病历中检索包括临床、人口统计学和实验室测量在内的母婴数据。
在311名入院的VLBW婴儿中，所有婴儿都有足够的血清肌酐和尿量数据。在纳入分析的301名患者中，41名（14%）被诊断为AKI，而仅12/301（4%）在出生后第一周被诊断。16名婴儿（5%）发生>1次AKI发作。7名（7/41，17%）为1期AKI，17名婴儿（17/41，42%）为2期和3期。在单因素分析中，脓毒症、动脉导管未闭、坏死性小肠结肠炎（NEC）以及出生后第一周的血流动力学不稳定在AKI组中更为常见。发生AKI的婴儿出生体重更低、孕周更早，且阿氏评分更低、CRIB II评分更高。在多因素分析中，NEC是与AKI相关的唯一显著危险因素。他们发生支气管肺发育不良（BPD）的风险也更高、住院时间更长且死亡率更高。
一组普遍早期接受咖啡因治疗的VLBW婴儿中，AKI发生率为14%，而出生后第一周仅有4%发生AKI。发生AKI的婴儿预后更差（BPD和死亡率）且住院时间更长。
