Clinico-Pathological Study of Acute Kidney Injury (AKI) in Term and Preterm New-Borns Admitted to a Tertiary Care Center

Background: Acute kidney injury (AKI), frequently involving patients admitted to the neonatal intensive care unit (NICU), is associated with poor outcomes and affects 18–70% of critically ill neonates. The present study was undertaken in the Department of Pediatrics, SCB Medical College & SVPPGIP, Cuttack to evaluate the occurrence of neonatal AKI and delineate the risk factors associated with it and short-term outcomes of AKI in neonates admitted in this hospital, which is a tertiary care center. Methodology: The study population included term and preterm sick neonates admitted to the NBU. The study was carried during the period December-2012 to September-2014. Newborns with no AKI with no other confounding factors were picked up to serve as control. Renal function parameters such as blood urea, serum creatinine, serum electrolytes, urinary sodium and creatinine were monitored on admission to NBU. Those babies having abnormal renal function had their laboratory parameters monitored every alternate day till discharge. Pediatric Urobag was used aseptically to collect urine over 24hrs. The Ultrasonographic examination performed in the study was done using gray scale real time machine (Nebula 402) employing a 5 to 7.5 MHZ transducer. All the details of the case were recorded in the proforma and analysed. The Statistical Products and Services Solutions (SPSS) software version 17.0 was used to analyze the data and created reports and graphs. Help of socialstatistics.com from Internet was taken to analyse the data. Results: In this prospective study 2100 newborns admitted to SNCU were screened for AKI based on urine output (<1ml/kg/hr), blood urea nitrogen and serum creatinine. Approx. 118 neonates (5.6%) of the hospitalised were affected by AKI. So the incidence of AKI is 5.6%. About 55.08% of the affected were Preterms. Males were affected more than females. Neonates weighing <2500 gm were around 72% which indicates that prematurity and low birth weight are risk factors for AKI. The most common causes of AKI were sepsis (72%), followed by birth asphyxia (28%), PDA (4.23%), RDS (3.38%), and PUV (2.5%). Both sepsis and birth asphyxia combined together contributed towards maximum number of AKI. Conclusion: The present study and observations clearly revealed that AKI is an increasingly recognised entity among critically ill neonates. In this study sepsis, birth asphyxia, RDS, PDA, PUV were common predisposing factors for AKI. Low birth weight and prematurity are important risk factors for the development of AKI. The most common causes of neonatal death in AKI in the present study was consistent with the most common causes of neonatal death including infections, prematurity and asphyxia. Higher mortality rate was associated with oliguric AKI states.