Exploring the prevalence and determinants of acute kidney injury in neonatal ICU patients: Insights from a low-middle income country

Neonatal acute kidney injury (AKI) represents a serious clinical concern, especially in intensive care settings where early organ dysfunction can significantly affect short-term recovery and long-term outcomes. This study investigated the occurrence of AKI and its relationship with perinatal and clinical parameters in a cohort of neonates admitted to a tertiary neonatal intensive care unit (NICU) in eastern Nepal. Conducted over 6 months, this hospital-based cross-sectional study included 454 neonates. Clinical assessment and laboratory findings guided the diagnosis of AKI, and statistical analysis was performed using χ2 testing and binary logistic regression to identify associations. Among the study population, 10.6% (n = 48) were diagnosed with AKI. The prevalence was similar across sexes, indicating no statistically significant difference between male (10%) and female (11.5%) neonates (P = .615). A significant association was found between prematurity and AKI, with preterm neonates showing a markedly higher risk (17.4%) compared to term infants (7.6%). Regression analysis confirmed this association, with preterm neonates having over fivefold increased odds of developing AKI (COR = 5.78, P = .008). Other factors significantly linked with AKI included in-hospital birth (P < .001), need for resuscitation at delivery (P = .021), hypoxic-ischemic encephalopathy (P = .043), and abnormal creatinine levels. Complications such as meconium-stained amniotic fluid, oliguria, meningitis, and intestinal obstruction also showed strong statistical associations (all P < .001). 85.4% of AKI-affected neonates were discharged alive, while 4.2% died and 10.4% were discharged against medical advice (P < .001). Although most had hospital stays under 14 days, a considerable proportion required prolonged care. The findings underscore the importance of proactive renal monitoring and early intervention strategies, particularly in preterm and clinically unstable neonates, to improve outcomes and reduce the burden of AKI in critical care settings.