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Abstract
OBJECTIVE: The study aimed to determine the prevalence of acute kidney injury (AKI) in term neonates with persistent pulmonary hypertension of the newborn (PPHN), to identify the probable risk factors, and to find its relation to mortality.
 
 METHODS: The study recruited 758 term neonates admitted to the neonatal ICU (NICU). Diagnosis of PPHN was established on the basis of clinical and echocardiographic criteria. For diagnosis of AKI, we adopted the modified Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition. This definition has three grades of AKI severity depending on degree of serum creatinine rise and urinary output. Patients were followed until they died or discharged from NICU.
 
 RESULTS: Among the 758 term neonates included in the study, there were 47 babies (6.2 %) fulfilling the criteria of PPHN. AKI was reported in 16 patients (34.0 %) and the reported mortality rate was 31.9 %. Neonates with AKI had significantly higher mortality rate when compared with patients without AKI (75.0 % versus 9.7 %; p = 0.0001). A significant association was noted between severe grades of PPHN and AKI.
 
 CONCLUSIONS: AKI is prevalent in neonates with PPHN. It is significantly associated with mortality. There is suggested link between AKI and severity of PPHN.
Highlights
Persistent pulmonary hypertension of the newborn (PPHN) is a serious clinical condition associated with significant mortality and detrimental complications (Roofthooft, Elema, Bergman, & Berger, 2011).One-year mortality varied from 7.6% in an American study (Steurer et al, 2017) to 39.5% in the Thai study of Nakwan and Pithaklimnuwong (2016) and 25.0 % in the Egyptian study of Abdel Mohsen and Amin (2013)
Acute kidney injury (AKI) was reported in 16 patients (34.0 %) and the reported mortality rate was 31.9 %
Neonates with AKI had significantly higher mortality rate when compared with patients without AKI (75.0 % versus 9.7 %; p = 0.0001)
Summary
One-year mortality varied from 7.6% in an American study (Steurer et al, 2017) to 39.5% in the Thai study of Nakwan and Pithaklimnuwong (2016) and 25.0 % in the Egyptian study of Abdel Mohsen and Amin (2013). This discrepancy in the mortality rates reflects the multi-dimensional difference between health systems in developed and developing countries which is one of the challenging issues in the management of PPHN. While ongoing research is underway to solve this problem (Jetton et al, 2016), the neonatal modified Kidney Disease: Improving Global Outcomes (KDIGO) AKI definition was recommended to unify and compare research outcomes in neonatal AKI (Selewski et al, 2015)
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