Spectrum of Acute Kidney Injury in Neonatal Intensive Care Unit at Combined Military Hospital Nowshera

Background: Neonatal acute kidney injury is a serious morbidity encountered in intensive care practice, commonly attributed to the vulnerability of immature renal physiology. A wide spectrum of etiologies contributes to neonatal AKI, ranging from sepsis or multiple organ dysfunction syndrome to obstructive and metabolic causes. Objective: To determine the spectrum of acute kidney injury in neonates admitted to the neonatal intensive care unit. Study Design: Prospective observational study. Duration and Place of Study: The study was conducted from February 2025 to May 2025 in the Neonatal Intensive Care Unit of Combined Military Hospital, Nowshera. Methodology: A total of 155 term neonates with acute kidney injury were enrolled through non-probability consecutive sampling. Diagnosis and staging of AKI were based on pediatric RIFLE criteria, with estimated glomerular filtration rate calculated using the Schwartz equation. Data collected included demographics, perinatal risk factors, and laboratory findings. Operational definitions were applied to classify sepsis/MODS, perinatal hypoxia, urinary obstruction, urinary infection, hypernatremic dehydration, and acute tubular necrosis. Results: The mean age of neonates was 16.48±8.98 days, and the mean birth weight was 2.23±0.72 kg. Males constituted 71.6% of cases. The most frequent etiology was sepsis/MODS (45.8%), followed by urinary obstruction (14.8%), perinatal hypoxia (14.2%), urinary infection (13.5%), hypernatremic dehydration (7.7%), and acute tubular necrosis (4.5%). Gender-based analysis revealed significant associations for urinary infection (p=0.036) and hypernatremic dehydration (p=0.005), both higher in females. Conclusion: Sepsis and MODS remain the leading etiologies of neonatal AKI, while obstructive and infectious causes are also prominent.