• Approaches to evaluation of fluid balance and management of fluid overload in neonates among neonatologists: a Neonatal Kidney Collaborative survey
    • Lindsey Gordon, Katarina Robertsson Grossmann, Ronnie Guillet, Heidi Steflik, Matthew W Harer, David J Askenazi, Shina Menon, David T Selewski, Michelle C Starr. J Perinatol. 2023 Oct;43(10):1314-1315.
    • Fluid overload, defined as pathologic positive fluid balance, is common in critically ill neonates and contributes to poor outcomes, including prolonged hospital stay and bronchopulmonary dysplasia. Maintaining appropriate fluid homeostasis is imperative in high-risk neonates. Little is known about the practices of assessing fluid balance and fluid management approaches in neonates. We aimed to understand current approaches to fluid balance assessment and management of fluid overload among neonatologists.
    • doi: 10.1038/s41372-023-01738-w
  • Acute Kidney Injury Defined by Fluid-Corrected Creatinine in Premature Neonates
    • Michelle C. Starr, MD, MPH; Russell L. Griffin, PhD; Matthew W. Harer, MD; et al. JAMA Netw Open. 2023;6(8):e2328182.
    • A total of 923 premature neonates (479 boys [51.9%]; median [IQR] birth weight, 801 [668-940] g) were included, of whom 215 (23.3%) received a diagnosis of AKI using uncorrected serum creatinine. After fluid balance correction, 13 neonates with AKI were reclassified as not having fluid-corrected AKI, and 111 neonates previously without AKI were reclassified as having fluid-corrected AKI (ie, unveiled AKI). Therefore, fluid-corrected AKI was diagnosed in 313 neonates (33.9%). Neonates with unveiled AKI were similar in clinical characteristics to those with AKI whose diagnoses were made with uncorrected serum creatinine. Compared with those without AKI, neonates with unveiled AKI were more likely to require ventilation (81 neonates [75.0%] vs 254 neonates [44.3%] and have longer hospital stays (median [IQR], 102 [84-124] days vs 90 [71-110] days). In multivariable analysis, a diagnosis of fluid-corrected AKI was associated with increased odds of adverse clinical outcomes, including ventilation (adjusted OR, 2.23; 95% CI, 1.56-3.18) and severe BPD (adjusted OR, 2.05; 95% CI, 1.15-3.64).
    • doi: 10.1001/jamanetworkopen.2023.28182
  • Caffeine and kidney function at two years in former extremely low gestational age neonates
    • Harer MW, Griffin R, Askenazi DJ, Fuloria M, Guillet R, Hanna M, Schuh MP, Slagle C, Woroniecki R; Neonatal Kidney Collaborative Research Committee; Charlton JR. Caffeine and kidney function at two years in former extremely low gestational age neonates. Pediatr Res. 2023 Sep 2.
    • 598 participants had at least one kidney metric at follow up. Within the whole cohort, postmenstrual age of caffeine discontinuation was not associated with any abnormal measures of kidney function at 2 years. In the stratified analysis, for each additional week of caffeine, the no BPD group had a 21% decreased adjusted odds of eGFR <90 ml/min/1.73m2 (aOR 0.78; CI 0.62–0.99) and the BPD group had a 15% increased adjusted odds of elevated BP (aOR 1.15; CI: 1.05–1.25).
    • doi: 10.1038/s41390-023-02792-y
  • Receipt of high-frequency ventilation is associated with acute kidney injury in very preterm neonates
    • Nicholas Haynes, Jeremiah Bell, Russel Griffin, David J. Askenazi, Jennifer Jetton & Alison L. Kent. for the Neonatal Kidney Collaborative. Pediatr Nephrol. 2023 Aug 18.
    • The incidence of AKI was highest in the CPAP/no ventilation group, followed by HFV, followed by conventional ventilation (CPAP/no ventilation 48.5% vs. HFV 42.6% vs. conventional ventilation 28.4% (p = 0.009). An increased risk for AKI was found for those on HFV compared to CPAP/no ventilation (HR = 2.65; 95% CI:1.22-5.73).
    • doi: 10.1007/s00467-023-06077-8
  • Neonatal nephrotoxic medication exposure and early acute kidney injury: results from the AWAKEN study
    • Heidi J. Steflik, Jennifer R. Charlton, Meagan Briley, David T. Selewski, Katja M. Gist, Mina H. Hanna, David Askenazi, Russell Griffin & Neonatal Kidney Collaborative. Journal of Perinatology. 2023 Apr 26.
    • Of 2162 neonates, 1616 (74.7%) received ≥1 nephrotoxic medication. Aminoglycoside receipt was most common (72%). AKI developed in 211(9.8%) neonates and was associated with a nephrotoxic medication exposure (p < 0.01). Nephrotoxic medication exposures including a nephrotoxic medication excluding aminoglycoside (aHR 3.14, 95% CI 1.31-7.55) and aminoglycoside and another nephrotoxic medication (aHR 4.79, 95% CI 2.19-10.50) were independently associated with AKI and severe AKI (stage 2/3), respectively.
    • doi: 10.1038/s41372-023-01684-7