January 2026: Acute Kidney Injury and Neurodevelopmental Outcomes in Extremely Premature Neonates
January 2026
. 2025 Nov 12;8(11):e2543270. doi: 10.1001/jamanetworkopen.2025.43270
Mina Hanna 1,✉, Valerie Y Chock 2, Nivedita Kamath 3, Anjali Raj 3, Jonathan R Swanson 4, Russell Griffin 5, David J Askenazi 5, Saudamini Nesargi 3
Purpose
Determine whether acute kidney injury (AKI) in extremely premature infants is associated with worse neurodevelopmental outcomes at 2 years of age.
Study Design/Patient Characteristics
This secondary study utilized data collected during the Preterm Erythropoietin Neuroprotection Trial (PENUT), which originally evaluated erythropoietin for neuroprotection. The cohort included 660 extremely low gestational age neonates (2427 weeks) from 30 NICUs across the US who survived and completed standardized neurodevelopmental follow-up at 2226 months corrected age using the Bayley Scales of Infant DevelopmentIII (BSID-III). Classification of Neurodevelopmental impairment (NDI) included the diagnosis of moderate to severe cerebral palsy, a BSID-III cognitive score <85, or BSID-III motor score <85 at 22 to 26 months corrected gestational age. Using the data collected from this trial, the neurodevelopmental outcomes of patients with AKI were compared to those without AKI.
Results
Death or moderate to severe NDI was higher in infants who had any AKI compared to those without AKI (55.4% vs 39.4%; P = .02). Additionally, neonates with any AKI were found to have 1.56 (95% CI, 1.05-2.34) higher adjusted odds of death or severe neurodevelopmental impairment and 1.94 (95% CI, 1.25-2.99) higher adjusted odds of cognitive scores <85. There was no difference found in neurodevelopmental impairment based on severity of AKI.
Implications
This association between AKI in extremely preterm infants with poor neurodevelopmental outcomes at 22 to 26 months corrected gestational age highlights the importance of early recognition, prevention, and longitudinal follow-up of AKI. These interventions are important not only in supporting survival but also in optimizing long-term neurodevelopment in this vulnerable population.
Determine whether acute kidney injury (AKI) in extremely premature infants is associated with worse neurodevelopmental outcomes at 2 years of age.
Study Design/Patient Characteristics
This secondary study utilized data collected during the Preterm Erythropoietin Neuroprotection Trial (PENUT), which originally evaluated erythropoietin for neuroprotection. The cohort included 660 extremely low gestational age neonates (2427 weeks) from 30 NICUs across the US who survived and completed standardized neurodevelopmental follow-up at 2226 months corrected age using the Bayley Scales of Infant DevelopmentIII (BSID-III). Classification of Neurodevelopmental impairment (NDI) included the diagnosis of moderate to severe cerebral palsy, a BSID-III cognitive score <85, or BSID-III motor score <85 at 22 to 26 months corrected gestational age. Using the data collected from this trial, the neurodevelopmental outcomes of patients with AKI were compared to those without AKI.
Results
Death or moderate to severe NDI was higher in infants who had any AKI compared to those without AKI (55.4% vs 39.4%; P = .02). Additionally, neonates with any AKI were found to have 1.56 (95% CI, 1.05-2.34) higher adjusted odds of death or severe neurodevelopmental impairment and 1.94 (95% CI, 1.25-2.99) higher adjusted odds of cognitive scores <85. There was no difference found in neurodevelopmental impairment based on severity of AKI.
Implications
This association between AKI in extremely preterm infants with poor neurodevelopmental outcomes at 22 to 26 months corrected gestational age highlights the importance of early recognition, prevention, and longitudinal follow-up of AKI. These interventions are important not only in supporting survival but also in optimizing long-term neurodevelopment in this vulnerable population.