February 2026: Acute kidney injury associated with increased costs in the neonatal intensive care unit: analysis of Pediatric Health Information System database
February 2026Acute kidney injury associated with increased costs in the neonatal intensive care unit: analysis of Pediatric Health Information System database
Authors: Heidi J Steflik, David T Selewski, Corinne Corrigan, Daniel L Brinton
J Perinatol. 2025;45(1):94-100. doi:10.1038/s41372-024-02193-x
Reviewer: Sitarah Mathias
Purpose: The study aimed to compare neonatal intensive care unit (NICU) hospitalization costs between neonates with and without acute kidney injury (AKI) and to identify specific clinical predictors that drive AKI-associated healthcare expenditures.
Study Design/Methods: This was a retrospective, multicenter cohort study utilizing the Children's Hospital Association (CHA) Pediatric Health Information System (PHIS) database. Demographics, clinical comorbidity data, length of hospitalization, diagnostic and procedure codes and cost-to-charge ratio (CCR) based adjusted total costs were collected for all surviving neonates of all gestational ages (GA) between 2015-2021. Adjusted hospitalization costs were compared between neonates and without AKI. Post-hoc subgroup analysis based on gestational age was also conducted.
Sample Characteristics: There were 304,725 surviving neonates where 3% (8774) had AKI. Among those with AKI, 19% (1682) were between 22-26 weeks GA, 59.9% (5257) were male and 45% (1238) weighed > 2.5kg.
Results: Neonates with AKI incurred substantially higher adjusted costs of $58,807 over their hospitalization compared to those without AKI. The primary drivers were lower gestational age and the presence of complex chronic conditions (cardiovascular, congenital/genetic, gastrointestinal, and dependency on medical technology). Lower gestational ages experienced longer hospital stays and higher costs in both groups, yet AKI was independently associated with increased hospital costs even after adjusting for clinical variables.
Implications: The independent association of AKI with increased hospitalization costs, particularly in the presence of comorbid conditions and lower gestational ages, underscore the significant economic impact of AKI and the need for cost-mitigation and AKI preventive strategies in the NICU