Acute kidney injury in neonates in a level - III NICU

ABSTRACT: Background: Acute kidney injury (AKI) is a common occurrence in the NICU with a variable incidence of 6-24% globally and is associated with increased morbidity and mortality. The cause of AKI is multifactorial. The identification of the risk factors and avoidance of the exposure at the earliest followed by application of patient specific treatment strategies is aimed at improving outcomes of neonatal AKI. Methods: A cross sectional descriptive study was conducted in the NICU of B.J Government Medical College and Sassoon Hospital, Pune with 95 neonates to determine the risk factors and short-term outcomes of neonates admitted with Acute kidney injury (AKI). Data was collected in a paper based proforma and variables for this study were analysed. Results: AKI was seen more in preterm neonates less than 32 weeks of gestation (56.84%). Mortality with AKI is significantly associated with prematurity (p=0.0032). AKI was more in low birth weight neonates (87%). The mean birth weight of the babies who succumbed were significantly lower than those who survived (p=0.004). Significantly higher number of cases with no birth asphyxia survived (p=0.02). Babies having AKI who had no evidence of intraventricular haemorrhage or sepsis, absence of indwelling central catheters had a better survival, (p-0.003), (p-0.0000001) and (p-0.0007) respectively. Mortality was significantly reduced in babies with AKI in whom aminoglycosides were not used (p=0.0001). A significantly higher number of deaths were observed with AKI stage 3 (p=0.00000183). Conclusion: Prematurity, sepsis, birth asphyxia, low birth weight, presence of indwelling central catheters, intraventricular haemorrhage and use of aminoglycosides were identified as risk factors of neonatal AKI. Stage 1 was associated with prolonged duration of hospital stay and greater survival. Monitoring and timely intervention in neonates can prevent the progression and outcome of AKI and will thus decrease early mortality. Keywords: Acute kidney injury, AKI, NICU