Acute Kidney Injury With a Miniaturized Extracorporeal Circuit for Neonatal Cardiopulmonary Bypass

Abstract

The objectives of this study were to evaluate the incidence and to identify risk factors for acute kidney injury (AKI) in neonates undergoing cardiopulmonary bypass (CPB) with a miniaturized bloodless primed extracorporeal circuit. A retrospective cohort study. A single-center, tertiary academic hospital. Data of 462 patients were analyzed. With a retrospective analysis of neonates undergoing CPB with bloodless priming between May 2007 and August 2019, the incidence of AKI was determined according to the neonatal Kidney Disease: Improving Global Outcomes classification. Multivariate logistic regression analyses were performed to determine risk factors for AKI. The incidence of AKI was 41.1% (190 of 462); 30.3% (n=140) had mild stage 1, 6.5% (n=30) reached stage 2, and 4.3% (n=20) reached stage 3. Multivariate logistic regression showed that degree of hypothermia (p=0.05), duration of CPB (p=0.03), and lower baseline serum creatinine (p < 0.001) were associated independently with AKI. In the authors' patient population, patients without transfusion of donor-derived erythrocytes had a lower incidence of AKI (p=0.003). AKI stages 2 and 3 were associated with longer duration of mechanical ventilation (p=0.008) and increased length of stay in the intensive care unit (p=0.03). With a miniaturized CPB circuit and bloodless priming, the AKI incidence was well within the range consistent with previously reported studies from other institutions.