Acute Kidney Injury and Bronchopulmonary Dysplasia in Premature Neonates Born Less than 32 Weeks' Gestation.
November 27, 2019Starr MC, Boohaker L, Eldredge LC, Menon S, Griffin R, Mayock DE, Li L, Askenazi D, Hingorani S; Neonatal Kidney Collaborative. Am J Perinatol. 2019 Nov 27.
Moderate or severe BPD occurred in 214 of 546 (39%) infants, while death occurred in 32 of 546 (6%); the composite of moderate or severe BPD/death occurred in 246 of 546 (45%). For infants born ≤29 weeks of gestation, the adjusted odds ratio (OR) of AKI and the primary outcome was 1.15 (95% confidence interval [CI] = 0.47-2.86; p = 0.76). Infants born between 29 and 32 weeks of gestation with AKI had four-fold higher odds of moderate or severe BPD/death that remained after controlling for multiple factors (adjusted OR = 4.21, 95% CI: 2.07-8.61; p < 0.001).
doi: 10.1055/s-0039-3400311
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Acute Kidney Injury is Associated with Poor Lung Outcomes in Infants Born ≥32 Weeks of Gestational Age.
November 18, 2019Starr MC, Boohaker L, Eldredge LC, Menon S, Griffin R, Mayock D, Askenazi D Hingorani S; Neonatal Kidney Collaborative. Am J Perinatol. 2019 Nov 18.
CLD occurred in 82/1,348 (6.1%) infants, while death occurred in 22/1,348 (1.6%); the composite of CLD/death occurred in 104/1,348 (7.7%). Infants with AKI had an almost five-fold increased odds of CLD/death, which remained after controlling for GA, maternal polyhydramnios, multiple gestations, 5-minute Apgar's score, intubation, and hypoxic-ischemic encephalopathy (adjusted odds ratio [OR] = 4.9, 95% confidence interval [CI]: 3.2-7.4; p<0.0001). Infants with AKI required longer duration of respiratory support (count ratio = 1.59, 95% CI: 1.14-2.23, p = 0.003) and oxygen (count ratio = 1.43, 95% CI: 1.22-1.68, p<0.0001) compared with those without AKI.
doi: 10.1055/s-0039-1698836
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The impact of fluid balance on outcomes in premature neonates: a report from the AWAKEN study group.
September 19, 2019Selewski DT, Gist KM, Nathan AT, Goldstein SL, Boohaker LJ, Akcan-Arikan A, Bonachea EM, Hanna M, Joseph C, Mahan JD, Mammen C, Nada A, Reidy K, Staples A, Wintermark P, Griffin R, Askenazi DJ, Guillet R; Neonatal Kidney Collaborative. Pediatr Res. 2019 Sep 19.
One hundred and forty-nine (14.8%) were on MV at postnatal day 7. The median peak FB was 0% (IQR: −2.9, 2) and occurred on postnatal day 2 (IQR: 1,5). Multivariable models showed that the peak FB (aOR 1.14, 95% CI 1.101.19), lowest FB in first postnatal week (aOR 1.12, 95% CI 1.071.16), and FB on postnatal day 7 (aOR 1.10, 95% CI 1.061.13) were independently associated with MV on postnatal day 7. In a similar analysis, a negative FB at postnatal day 7 protected against the need for MV at postnatal day 7 (aOR 0.21, 95% CI 0.120.35).
doi: 10.1038/s41390-019-0579-1
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The Association of Intraventricular Hemorrhage and Acute Kidney Injury in Premature Infants from the Assessment of the Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) Study.
August 28, 2019Stoops C., Boohaker L., Sims B., Griffin R., Selewski D.T., Askenazi D., on behalf of the National Kidney Collaborative (NKC). Neonatology. 2019 Aug 28:1-10.
AKI was documented in 22.2% (183/825) of infants and IVH in 14.3% (118/825). Infants with AKI (n = 183) were more likely to have IVH (26.8%, 49/183) than those without AKI (n= 642) who had IVH (10.7%, 69/642, p < 0.0001). After controlling for 5-min Apgar score, vasopressor support within the first week of age, and gestational age, infants with AKI had 1.6 times higher adjusted odds to develop any grade IVH (95% CI 1.042.56). Furthermore, infants of gestational age of 2228 weeks had 1.9 times higher adjusted odds to develop IVH (OR 1.87, 95% CI 1.083.23).
doi: 10.1159/000501708
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Incidence and Risk Factors of Early Onset Neonatal AKI
February 20, 2019Jennifer R. Charlton, Louis Boohaker, David Askenazi, Patrick D. Brophy, Carl D'Angio, Mamta Fuloria, Jason Gien, Russell Griffin, Sangeeta Hingorani, Susan Ingraham, Ayesa Mian, Robin K. Ohls, Shantanu Rastogi, Christopher J. Rhee, Mary Revenis, Subrata Sarkar, Alexandra Smith, Michelle Starr, Alison L. Kent and on behalf of the Neonatal Kidney Collaborative. CJASN February 2019
In over 2,000 patients, early AKI (≤7 days) occurred in 21% of neonates. Infants with early AKI had higher risk of death (aOR 2.8, 95% CI 1.7 to 4.7) and longer length of stay (7.3 days, 95% CI 4.7 to 10). Risk factors for early AKI are: outborn delivery; resuscitation with epinephrine; admission diagnosis of hyperbilirubinemia, inborn errors of metabolism, or surgical need; frequent kidney function surveillance; and admission to a children's hospital. Protective factors were: multiple gestations, cesarean section, and exposures to antimicrobials, methylxanthines, diuretics, and vasopressors.< [..] read more