Incidence, Risk Factors, and Outcomes of Acute Kidney Injury in Necrotizing Enterocolitis: A Prospective Single-Center Study.

Abstract

Necrotizing enterocolitis (NEC) is a significant cause of morbidity and mortality in the neonatal intensive care unit (NICU). Acute kidney injury (AKI) is considered to be one of the most well-established risk factors for mortality in neonates. The aim of this work was to study the incidence of AKI in neonates with NEC and to determine the associated conditions, risk factors, and outcomes. We carried out this prospective cross-sectional study on 104 neonates treated for NEC from September 2015 to September 2019. Diagnoses of AKI were made using the neonatal modified Kidney Disease: Improved Global Outcome criteria. AKI occurred in 63 neonates (61%), with 32 at Stage 1 (31%), 20 at Stage 2 (19%), and 11 at Stage 3 (11%), including three requiring dialysis. Vancomycin use and positive blood culture were risk factors for developing AKI in our NEC neonates (odds ratio: 2.47 and 2.41; P = 0.03 and 0.04, respectively). Neonates with AKI had a higher mortality rate (47.6% vs. 26.8 %, P = 0.03) and an increased length of stay (LOS) (69.8 days vs. 53.9 days, P <0.01) than the non-AKI group. Surgical intervention was required in 11 (10.5%) of our neonates. We concluded that AKI occurs in about 60% of neonates with NEC and is associated with higher mortality and LOS in the NICU. Therefore, it is very important to identify and manage all neonates who are at a high risk of developing AKI as quickly as possible.