Late onset neonatal acute kidney injury: results from the AWAKEN study.
December 13, 2018Jennifer R. Charlton, Louis Boohaker, David Askenazi, Patrick D. Brophy, Mamta Fuloria, Jason Gien, Russell Griffin, Sangeeta Hingorani, Susan Ingraham, Ayesa Mian, Robin K. Ohls, Shantanu Rastogi, Christopher J. Rhee, Mary Revenis, Subrata Sarkar, Michelle Starr, Alison L. Kent & on behalf of the Neonatal Kidney Collaborative (NKC). Pediatric Research, December 2018
In over 2,000 patients, late AKI (> 7 days after birth) occurred in 9% of neonates. Infants with late AKI had increased risk of death (aOR 2.1, p=0.02) and longer length of stay (21.9, p<0.001). Risk factors for late AKI are: intubation, oligo- and polyhydramnios, mild-moderate renal anomalies, admission diagnoses of congenital heart disease, necrotizing enterocolitis, surgical need, exposure to diuretics, vasopressors, and NSAIDs, discharge diagnoses of patent ductus arteriosus, necrotizing enterocolitis, sepsis, and urinary tract infection.
doi: 10.1038/s41390-018-0255-x
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Optimizing the AKI definition during the first postnatal week using Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) cohort.
December 13, 2018David Askenazi, Carolyn Abitbol, Louis Boohaker, Russell Griffin, Rupesh Raina, Joshua Dower, T. Keefe Davis, Patricio E. Ray, Sofia Perazzo, Marissa DeFreitas, Lawrence Milner, Namasivayam Ambalavanan, F. Sessions Cole, Erin Rademacher, Michael Zappitelli, Maroun Mhanna & for the Neonatal Kidney Collaborative. Pediatric Research, December 2018
The absolute rise in serum creatinine of 0.3 mg/dL outperformed a ≥50% rise in serum creatinine during the first week of life for predicting mortality. The optimal serum creatinine thresholds to predict AUC and specificity were ≥0.3 and ≥0.6 mg/dL for ≤29 weeks gestational age and ≥0.1 and ≥0.3 mg/dL for > 29 week gestational age. The maximum serum creatinine value provides great specificity.
doi: 10.1038/s41390-018-0249-8
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Correction to: Acute kidney injury in neonatal encephalopathy: an evaluation of the AWAKEN database
October 12, 2018Megan J Kirkley, Louis Boohaker, Russell Griffin, Danielle E Soranno, Jason Gien 6, David Askenazi, Katja M Gist; Neonatal Kidney Collaborative (NKC). Pediatr Nephrol. 2019 Feb;34(2):363
Erratum for "Acute kidney injury in neonatal encephalopathy: an evaluation of the AWAKEN database." Kirkley MJ, Boohaker L, Griffin R, Soranno DE, Gien J, Askenazi D, Gist KM; Neonatal Kidney Collaborative (NKC). Pediatr Nephrol. 2019 Jan;34(1):169-176. doi: 10.1007/s00467-018-4068-2. Epub 2018 Aug 28. PMID: 30155763
doi: 10.1007/s00467-018-4106-0
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The impact of fluid balance on outcomes in critically ill near term/term neonates: a report from the AWAKEN study group.
September 20, 2018David T. Selewski, Ayse Akcan-Arikan, Elizabeth M. Bonachea, Katja M. Gist, Stuart L. Goldstein, Mina Hanna, Catherine Joseph, John D. Mahan, Arwa Nada, Amy T. Nathan, Kimberly Reidy, Amy Staples, Pia Wintermark, Louis J. Boohaker, Russell Griffin, David J. Askenazi, Ronnie Guillet & on behalf of the Neonatal Kidney Collaborative. Pediatric Research, September 2018.
The median peak fluid balance was 1.0% and occurred on post-natal day 3. Multivariable models showed the peak fluid balance, lowest fluid balance in 1st postnatal week and fluid balance on postnatal day 7 were independently associated with need for mechanical ventilation on postnatal day 7.
doi: 10.1038/s41390-018-0183-9
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Acute kidney injury in neonatal encephalopathy: an evaluation of the AWAKEN database.
August 28, 2018Megan J. Kirkley, Louis Boohaker, Russell Griffin,Danielle E. Soranno, Jason Gien, David Askenazi, Katja M. Gist, On behalf of the Neonatal Kidney Collaborative (NKC). Pediatric Nephrology, August 2018.
Of 113 patients with neonatal encephalopathy, 41.6% developed AKI. Risk factors for AKI were outborn, IUGR and presence of meconium at delivery. AKI resulted in longer hospital stays (8.5 days, 95% CI 0.79-16.2).
doi: 10.1007/s00467-018-4068-2
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Correction: Incidence of neonatal hypertension from a large multicentre study [Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates-AWAKEN]
August 8, 2018Emily J Kraut, Louis J Boohaker, David J Askenazi, Jeffery Fletcher, Alison L Kent; Neonatal Kidney Collaborative (NKC). Pediatr Res. 2018 Aug;84(2):314
Erratum for "Incidence of neonatal hypertension from a large multicenter study [Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates-AWAKEN]." Kraut EJ, Boohaker LJ, Askenazi DJ, Fletcher J, Kent AL; Neonatal Kidney Collaborative (NKC). Pediatr Res. 2018 Aug;84(2):279-289. doi: 10.1038/s41390-018-0018-8. Epub 2018 May 23. PMID: 29795211
doi: 10.1038/s41390-018-0107-8
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Incidence of neonatal hypertension from a large multicenter study [Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates – AWAKEN]
May 23, 2018Emily J. Kraut, Louis J. Boohaker, David J. Askenazi, Jeffery Fletcher, Alison L. Kent & on behalf of the Neonatal Kidney Collaborative (NKC). Pediatric Research. May 2018
Of over 2,000 infants, hypertension was documented in 1.8% and an additional 3.7% were defined as having undiagnosed hypertension. Hypertension was associated with a diagnosis of AKI and other risk factors for HTN were hyperbilirubinemia, Caucasian race, outborn, vaginal delivery and congenital heart disease. Protective factors were SGA, multiple gestation and maternal betamethasone.
doi: 10.1038/s41390-018-0018-8
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Association Between Early Caffeine Citrate Administration and Risk of Acute Kidney Injury in Preterm Neonates: Results from the AWAKEN Study.
April 2, 2018Harer MW, Askenazi DJ, Boohaker LJ, Carmody JB, Griffin RL, Guillet R, Selewski DT, Swanson JR, Charlton JR, Neonatal Kidney Collaborative (NKC). JAMA Pediatrics. April 2018
Of 675 preterm infants ≤ 33 weeks, AKI occurred less frequently in neonates who received caffeine than those who did not (50 of 447 (11.2%) vs. 72 of 228 (31.6%), P<0.01). After multivariable adjustment, the number needed to treat to prevent one case of AKI was 4.3 and those receiving caffeine were less likely to develop high grade AKI (stage 2 or 3, OR 0.20, 95% CI 0.12-0.34).
doi: 10.1001/jamapediatrics.2018.0322
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