G448(P) Acute kidney injury in neonates

Abstract

Background Neonatal Acute Kidney Injury (AKI) is often defined as a rise in Serum Creatinine (SCr) from baseline to more than 120 mmol/L. Incidence depends on age, gestation and other concurrent illness. Reporting of AKI in neonates is reliant on regular and adequate monitoring of renal function of Neonates, further complicated by the fact that initial SCr measurements reflect maternal renal function. Aim To ascertain the incidence of AKI in a tertiary neonatal unit in Aberdeen, the underlying aetiology and follow up plans. Methods We reviewed all admitted babies who had high SCr (≥120 mmol/L measured after 48 hours of age), over a 4 year period from August 2013 till September 2017. There are nearly 900 admissions annually. Results Of all the neonates who had SCr measured, 35 patients had AKI during the 4 year period. Gestational age of the affected babies varied between 23+5–27+6 weeks: 6 (17.1%), 28–31+6 weeks: 2 (5.7%), 32–35+6 weeks: 9 (25.7%),≥36 weeks: 18 (51.4%)). Common primary diagnosis in term babies was HIE, 11 (31.4%) and 4 (11%) babies had foetal renal anomalies 27 (77%) had their renal function normalised subsequently. The 4 antenatally identified babies were confirmed to have renal issues requiring further follow up. This included diagnoses of Obstructive Uropathy (2), Multi-cystic dysplastic kidney (1) and bilateral dysplastic kidneys (1). A further baby was noted to have a renal infarct. Renal Ultrasounds were done on 18 (51.4%). 10 babies (55.6%) had normal scans. Of the 35 babies, 22 (62.8%) were discharged home from the unit, 3 (8.6%) were transferred to a tertiary centre and 10 (28.6%) died. Of the 22 discharged, follow up was arranged for 21 babies. Developmental follow up for 14 (67%), renal review and follow up: 7 babies 4 (19%) locally and 3 (36%) in a specialised centre. Discussion and recommendation AKI in neonates is not uncommon and carries a significant risk of mortality and morbidity. Outcome largely depends on the underlying aetiology. Babies with identified AKI should have their renal function monitored regularly during admission, with a robust follow up plan on discharge.