BACKGROUND

Acute kidney injury (AKI) is common in the neonatal intensive care unit (NICU) and is associated with increased morbidity and mortality. Mounting evidence suggests infants with AKI in the NICU have higher risks of long-term kidney dysfunction, such as chronic kidney disease. However, guidelines for outpatient kidney-focused follow-up practices are lacking.

METHODS

As part of the National Institutes of Health-sponsored Consensus Workshop to Address Kidney Health in Neonatal Intensive Care Unit Graduates, a multidisciplinary workgroup within the US performed an in-depth review of the medical literature on term and late preterm (i.e. ≥ 34 weeks gestation) neonates admitted to the NICU with AKI to inform consensus recommendations for outpatient kidney health monitoring for high-risk and at-risk infants.

RESULTS

In this modified Delphi consensus statement, the workgroup developed three consensus recommendations and identified priority research gaps and opportunities for future study. Specific recommendations include completing a NICU discharge kidney health evaluation followed by a comprehensive kidney health assessment six months after discharge for high-risk infants and at two years of age for high-risk and at-risk infants.

CONCLUSIONS

Critically ill term and late preterm infants with AKI have an increased risk of long-term kidney dysfunction and merit evaluation at NICU discharge with subsequent comprehensive kidney health assessments based on risk factors. Current research gaps and opportunities for improved care include identifying optimal pre-discharge planning approaches, examining the impacts of different etiologies and severity of AKI on long-term kidney and overall health, exploring modification to current AKI diagnosis standards, and development of high-yield educational tools for families and providers.