Neonatal Kidney Research Articles

Study of neonatal acute kidney injury based on KDIGO criteria

Significant advancement has occurred over the years in diagnosis, recognition, intervention and impact of acute kidney injury (AKI) on morbidity and mortality in critically-ill neonates. However an increased risk of chronic kidney disease (CKD) is still observed among neonates who survive an episode of AKI. Therefore, preventing and adequately managing AKI in neonates could help in controlling long-term renal morbidity in neonates who develop AKI. Thus, this study was undertaken with the aim of studying the incidence, contributing factors and outcomes of AKI in at-risk term neonates admitted to the neonatal intensive care unit (NICU). One hundred and ninety-six term neonates admitted to the NICU with sepsis, hypoxic ischemic encephalopathy (HIE), dehydration and respiratory distress were enrolled and evaluated over a period of one year. Detailed maternal history along with neonatal history, anthropometry, vitals and clinical signs of neonates were recorded in a pretested proforma. Urine output was measured in all at-risk neonates. Serum creatinine was estimated to categorize AKI into stages as per modified KDIGO criteria. Incidence of AKI was 21%, (n=107 out of 510 admissions) in the study. Mortality was significantly higher in AKI stage III neonates (88.9%) (p<0.001). Multivariate analysis revealed that hypoxic ischemic encephalopathy (HIE) had 35.293 (p<0.001) times higher risk, while sepsis had 35.701 (p<0.001), dehydration had 30.260 times (p<0.001) and respiratory distress had 10.366 times (p<0.001) higher risk of developing AKI. Our study recorded a high incidence of AKI among at-risk neonates. KDIGO criteria for diagnosing AKI is feasible to apply in the at-risk neonates and helps in its early identification. Early diagnosis and timely intervention in neonates with HIE, sepsis, dehydration and respiratory can prevent the progression of AKI and thus improve prognoses.

Renal biomarkers of acute kidney injury in response to increasing intermittent hypoxia episodes in the neonatal rat

BackgroundWe tested the hypotheses that: 1) early exposure to increasing episodes of clinically relevant intermittent hypoxia (IH) is detrimental to the developing kidneys; and 2) there is a critical number of daily IH episodes which will result in irreparable renal damage that may involve angiotensin (Ang) II and endothelin (ET)-1.MethodsAt birth (P0), neonatal rat pups were exposed to brief IH episodes from the first day of life (P0) to P7 or from P0-P14. Pups were either euthanized immediately or placed in room air (RA) until P21. RA littermates served as controls. Kidneys were harvested at P7, P14, and P21 for histopathology; angiotensin converting enzyme (ACE), ACE-2, ET-1, big ET-1, and malondialdehyde (MDA) levels; immunoreactivity of ACE, ACE-2, ET-1, ET-2, ET receptors (ETAR, ETBR), and hypoxia inducible factor (HIF)1α; and apoptosis (TUNEL stain).ResultsHistopathology showed increased renal damage with 8–12 IH episodes/day, and was associated with Ang II, ACE, HIF1α, and apoptosis. ACE-2 was not expressed at P7, and minimally increased at P14. However, a robust ACE-2 response was seen during recovery with maximum levels noted in the groups recovering from 8 IH episodes/day. ET-1, big ET-1, ETAR, ETBR, and MDA increased with increasing levels of neonatal IH.ConclusionsChronic neonatal IH causes severe damage to the developing kidney with associated elevations in vasoconstrictors, suggesting hypertension, particularly with 8 neonatal IH episodes. ACE-2 is not activated in early postnatal life, and this may contribute to IH-induced vasoconstriction. Therapeutic targeting of ACE and ET-1 may help decrease the risk for kidney injury in the developing neonate to prevent and/or treat neonatal acute kidney injury and/or chronic kidney disease.

Improving the identification of acute kidney injury in the neonatal ICU: three centers' experiences.

To describe three different standardized approaches to improving neonatal acute kidney injury (AKI) identification and the impact on AKI identification, incidence, and nephrology consultation and referral. A retrospective cohort study in three academic NICUs. We compared AKI identification, AKI incidence, nephrology consultation, and nephrology follow-up before and after implantation of local protocols to standardize neonatal AKI identification. Neonatal AKI identification improved in all three NICUs following protocol implementation (26-85%, P < 0.0001). Each center also saw increases in nephrology consultation (15-83%, P < 0.0001) and nephrology follow-up (7-73%, P < 0.0001). AKI incidence decreased significantly (21-12%, P < 0.0001). Multiple strategies can be successfully operationalized to improve neonatal AKI identification. While different in approach, each strategy resulted in increased AKI identification and nephrology involvement. This study emphasizes the importance of local standardized approaches to AKI to improve AKI identification and nephrology involvement in the NICU.

Prediction of risk factors and outcomes of neonatal acute kidney injury

IntroductionNeonatal Acute kidney injury (AKI) is an underestimated morbidity in the neonatal intensive care unit (ICU). However, there is a paucity of information about risk factors, outcomes, and possible preventive measures to limit its occurrence.AimThis study aimed to determine the prevalence of neonatal AKI in a neonatal ICU. Data obtained from this study will help to better understand current local practices and investigate possible preventive strategies.Materials and methodsCharts from January 2011 to December 2018 were reviewed. Neonates less than 2 weeks old who depended on intravenous fluid as a nutrition source for at least two days were included.ResultsOverall, the eight-year prevalence of neonatal AKI in the neonatal ICU was 19.6%, and severity was distributed as follows: stage 1 (46.2%), stage 2 (26.5%), and stage 3 (27.3%). Caffeine administration before 29 weeks’ gestational age significantly decreased the incidence of neonatal AKI. The incidence of neonatal AKI was independently associated with death (odds ratios (OR) = 7.11, P < 0.001) and extended length of hospital stay (OR = 2.47, P < 0.001). In the multivariate regression model, vancomycin (AOR = 1.637, P < 0.004), loop diuretics (AOR = 2.203, P < 0.001), intraventricular hemorrhage (AOR = 2.605, P < 0.001), surgical intervention (AOR = 1.566, P < 0.008), mechanical ventilation (AOR = 1.463, P < 0.015), and dopamine administration (AOR = 2.399, P < 0.001) were independently associated with neonatal AKI.ConclusionNeonatal AKI occurred in one-fifth of the study population in a neonatal ICU. Outcomes can be improved by identifying high-risk infants and cautiously monitoring kidney function.

FREQUENCY OF CONGENITAL ANOMALIES OF THE KIDNEY AND URINARY TRACT BY MEANS OF ULTRASONOGRAPHY IN NEONATES AT A TERTIARY-CARE HOSPITAL

Objective: To determine the frequency of congenital anomalies of the kidney and urinary tract by means of ultrasound in neonates.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Radiology and Diagnostic Imaging, Rehman Medical Institute, Peshawar, from May 2015 to Jan 2016.&#x0D; Methodology: A total of 150 neonates reporting for routine abdominal ultrasonography were included. Honda Convex Scanner model HS-2000 with probe of frequency of 5-7 MHz was used for the ultrasonography.&#x0D; Results: Mean age of the neonates was 13.8 ± 7.5 days. Seventy-six (50.7%) were male and 74 (49.3%) were female. Congenital anomalies of the kidney and urinary tract were observed in 10 (6.7%) neonates. Most neonates had more than one anomaly. The left side was involved in 6 (4%) neonates while right side was involved in 4 (2.7%). Hydronephrosis was the most common abnormality found in 8 (5.3%) cases. The location of kidneys was abnormal (ectopic) in 2 (1.3%) neonates. Abnormal dimension was seen in seven cases and abnormal corticomedullary differentiation was found in 5 (3.3%) cases. Non-symmetrical cases were 5 (3.3%). Hydroureter was observed in 3 (2%) neonates and urinary bladder was abnormal in 2 (1.3%) neonates.&#x0D; Conclusion: The frequency of congenital anomalies of the kidney and urinary tract in neonates by means of postnatal ultrasonographic scan in our study population was 6.7%. Hydronephrosis was the most common anomaly.

Association between Elevated Urine Neutrophil Gelatinase-Associated Lipocalin and Postoperative Acute Kidney Injury in Neonates

To examine the incidence of postoperative neonatal acute kidney injury (AKI) following general surgical procedures and to test the hypothesis that postoperative urine neutrophil gelatinase-associated lipocalin (uNGAL) concentrations predict AKI. The secondary objective was to evaluate for an association between AKI and hospital mortality. Prospective observational study of infants undergoing abdominal and thoracic surgical procedures in the neonatal intensive care unit from October 2018 to March 2020. The primary outcome was incidence of neonatal AKI (defined by the neonatal modified Kidney Diseases Improving Global Outcomes criteria) following each procedure to postoperative day 5. Severe AKI was defined as stage 2 or 3 AKI. Urine samples were obtained pre- and postoperatively at 6 time points to evaluate for levels of uNGAL. Secondary outcomes were in-hospital mortality and length of stay. Subjects (n=141) underwent a total of 192 general surgical procedures during the study period. Neonatal AKI and severe AKI occurred following 36 (18%) and 15 (8%) procedures (n=33 subjects). Percent change of uNGAL from 24hours preoperatively to 24hours postoperatively was greater in subjects with neonatal AKI (190.2% [IQR 0.0, 1666.7%] vs 0.7% [IQR -31.2%,140.2%], P=.0374). The strongest association of uNGAL and AKI occurred at 24hours postoperatively (area under the receiver operator curves of 0.81, 95% CI 0.72, 0.89). Increased mortality risk was observed in subjects with any postoperative AKI (aOR 11.1 95% CI 2.0, 62.8, P=.0063) and severe AKI (aOR 13.8; 95% CI 3.0, 63.1, P=.0007). Elevation in uNGAL 24hours postoperative was associated with AKI. Neonates with postoperative AKI had increased mortality.

НЕОНАТАЛЬНОЕ ОСТРОЕ ПОВРЕЖДЕНИЕ ПОЧЕК: ИНФОРМИРОВАННОСТЬ ВРАЧЕЙ ОТДЕЛЕНИЙ РЕАНИМАЦИИ НОВОРОЖДЕННЫХ И ВРАЧЕЙ ДРУГОГО ПЕДИАТРИЧЕСКОГО ПРОФИЛЯ

Neonatal acute kidney injury (AKI) is common in newborns in critical condition in the intensive care units and significantly reduces the chances of recovery. The analysis of attitudes to this problem and the practical experience of pediatric doctors working with newborns regarding the risks of development and outcomes of AKI is an important step in improving the prognosis of the disease. Objective of the study: determination of awareness of the problem of neonatal AKI. Materials and methods of research: the study was carried out in the form of a sociological survey (questionnaire) of doctors (n=63) working in neonatal intensive care units (NICU) (n=34, 54%), and pediatricians not associated with work in the NICU (n=29, 46%). The questionnaire contained 34 questions. 51% of the respondents (n=32) were under 40 years old, 49% – over 40 years old (n=31). Results: there is a lack of awareness of specialists regarding definitions, diagnostics, treatment tactics, prognosis of the disease, as well as insufficient availability of treatment facilities for access to nephrological and dialysis care. 29% (95% CI 14–44%, n=10) NICU doctors and 21% (95% CI 6–36%, n=6) doctors from other departments were unaware of the existing AKI classifications in newborns (p=0,615). 62% (95% CI 46–78%, n=21) of NICU staff and 55% (95% CI 37–73%, n=16) by doctors of other specialties (p=0,785) reported that nephrology counseling was available. The availability of renal replacement therapy was reported by 27% (95% CI 12–42%, n=9) by NICU doctors and 35% (95% CI 18–52%, n=10) by doctors from other departments (p=0,678). Only 52 (83%) (95% CI 74–92%) doctors believe that the child should be examined by a nephrologist. Conclusion: it is necessary to raise awareness among doctors about neonatal AKI.

The lower threshold of hypothermic oxygen delivery to prevent neonatal acute kidney injury.

Oxygen delivery during cardiopulmonary bypass (CPB) is closely related to postoperative acute kidney injury (AKI). The value of critical indexed oxygen delivery (DO2i) is a key indicator to reflect oxygen supply in cardiovascular surgery. However, the target DO2i value for neonates undergoing hypothermic CPB remains unclear. One hundred and twenty-six consecutive newborns (≤28 days) undergoing arterial switch operations were retrospectively divided into two groups according to AKI occurrence. Baseline characteristics, intraoperative variables, and clinical outcomes were collected. Multivariate logistic regression analysis and receiver-operating characteristic curve were performed to investigate the association between DO2i and AKI. Neonates in the no-AKI group (n = 67) had significantly higher nadir bypass flow and DO2i during the hypothermic phase compared with the AKI group (n = 59). AKI group had remarkably higher incidences of hepatic dysfunction and peritoneal dialysis requirement compared with newborns without AKI. Mixed venous oxygen saturation (SvO2) was comparable between the two groups. Base excess (BE)(P = 0.011) value during the hypothermic phase of the AKI group was higher than the no-AKI group. Multivariate analysis showed that hypothermic DO2i was negatively associated with AKI. The cut-off value of hypothermic DO2i was 269 mL min-1 m-2. The importance of hypothermic DO2i should be highlighted, even when SvO2 was satisfactory. A lower threshold of DO2i > 269 mL min-1 m-2 may help protect neonates from the risk of postoperative AKI. The key message of our article is that the lower threshold of DO2i > 269 mL min-1 m-2 may help protect neonates from the risk of AKI after on-pump hypothermic cardiovascular surgery. The critical DO2i value for neonates undergoing hypothermic CPB remains unclear, and our study may add new evidence for this matter based on the 6-year experience of our center. In this study, the lowest critical value of DO2i in neonatal hypothermic CPB is determined for the first time, which provides a reference for intra-CPB management strategy to improve the postoperative outcomes of newborns.

Incidence, Risk Factors, and Outcomes of Neonatal Acute Kidney Injury: Protocol of a Multicentric Prospective Cohort Study [The Indian Iconic Neonatal Kidney Educational Registry

Background: Acute kidney injury (AKI) is a significant problem in neonates, but the evidence is sparse. Neonatal AKI is an independent risk factor for increased mortality and prolonged hospital stay. There are stark differences in the epidemiology of AKI in neonates amongst the developing and the developed world. Increased prevalence of neonatal sepsis, lack of awareness about neonatal AKI and poor access to pediatric nephrologists add to the improper management of neonatal AKI in the developing countries.Methods: This study is a multicentric, national, prospective cohort study [The Indian iconic Neonatal Kidney Educational Registry (TINKER)] conducted in level 2–3 NICUs in 11 centers across India. We have enrolled nearly 2,000 neonates over the study period. Neonates (≤ 28 days) who were admitted in NICU and those who received intravenous (IV) fluids for at least 48 h for hydration and/or nutrition have been included. Data collection included: (1) baseline demographics (2) daily physiologic and laboratory parameters (3) discharge data. KDIGO workgroup AKI definition modified for neonates was used for defining AKI. Data entry was carried out by individual participating centers using a web-based database (akiregistry.org). De-identified data has been maintained and handled by the principal investigator (PI). This collaboration plans to disseminate data through peer-reviewed publications and through presentations at educational conferences.Conclusions: The purpose of this study is to create the first prospective neonatal all-cause AKI data repository and describe the incidence of neonatal AKI in NICUs in the country and determine the risk factors as well as the outcomes of such neonates—both short-term and long-term outcomes. This will eventually spur therapeutic advancements, facilitate decipherment of epidemiological trends, risk factors as well as outcomes and identify disparities in management across the nation.

Schmallenberg virus infection suspected in a calf born to an imported heifer.

Schmallenberg virus infection suspected in a calf born to an imported heifer.

Epidemiology of Acute Kidney Injury After Neonatal Cardiac Surgery: A Report From the Multicenter Neonatal and Pediatric Heart and Renal Outcomes Network.

Cardiac surgery-associated acute kidney injury occurs commonly following congenital heart surgery and is associated with adverse outcomes. This study represents the first multicenter study of neonatal cardiac surgery-associated acute kidney injury. We aimed to describe the epidemiology, including perioperative predictors and associated outcomes of this important complication. This Neonatal and Pediatric Heart and Renal Outcomes Network study is a multicenter, retrospective cohort study of consecutive neonates less than 30 days. Neonatal modification of The Kidney Disease Improving Global Outcomes criteria was used. Associations between cardiac surgery-associated acute kidney injury stage and outcomes (mortality, length of stay, and duration of mechanical ventilation) were assessed through multivariable regression. Twenty-two hospitals participating in Pediatric Cardiac Critical Care Consortium. Twenty-two-thousand forty neonates who underwent major cardiac surgery from September 2015 to January 2018. None. Cardiac surgery-associated acute kidney injury occurred in 1,207 patients (53.8%); 983 of 1,657 in cardiopulmonary bypass patients (59.3%) and 224 of 583 in noncardiopulmonary bypass patients (38.4%). Seven-hundred two (31.3%) had maximum stage 1, 302 (13.5%) stage 2, 203 (9.1%) stage 3; prevalence of cardiac surgery-associated acute kidney injury peaked on postoperative day 1. Cardiac surgery-associated acute kidney injury rates varied greatly (27-86%) across institutions. Preoperative enteral feeding (odds ratio = 0.68; 0.52-0.9) and open sternum (odds ratio = 0.76; 0.61-0.96) were associated with less cardiac surgery-associated acute kidney injury; cardiopulmonary bypass was associated with increased cardiac surgery-associated acute kidney injury (odds ratio = 1.53; 1.01-2.32). Duration of cardiopulmonary bypass was not associated with cardiac surgery-associated acute kidney injury in the cardiopulmonary bypass cohort. Stage 3 cardiac surgery-associated acute kidney injury was independently associated with hospital mortality (odds ratio = 2.44; 1.3-4.61). No cardiac surgery-associated acute kidney injury stage was associated with duration of mechanical ventilation or length of stay. Cardiac surgery-associated acute kidney injury occurs frequently after neonatal cardiac surgery in both cardiopulmonary bypass and noncardiopulmonary bypass patients. Rates vary significantly across hospitals. Only stage 3 cardiac surgery-associated acute kidney injury is associated with mortality. Cardiac surgery-associated acute kidney injury was not associated with any other outcomes. Kidney Disease Improving Global Outcomes criteria may not precisely define a clinically meaningful renal injury phenotype in this population.

Fluid management, electrolytes imbalance and renal management in neonates with neonatal encephalopathy treated with hypothermia

Kidney dysfunction and acute kidney injury (AKI) frequently accompanies neonatal encephalopathy and contributes to neonatal morbidity and mortality. While there are currently no proven therapies for the treatment of AKI, understanding the pathophysiology along with early recognition and treatment of alterations in fluid, electrolyte and metabolic homeostasis that accompany AKI offer opportunity to reduce associated morbidity. Promising new tests and technologies, including urine and serum biomarkers and renal near-infrared spectroscopy offer opportunities to improve diagnosis and monitoring of neonates at risk for kidney injury. Furthermore, recent advances in neonatal kidney supportive therapies such as hemofiltration and hemodialysis may further improve outcomes in this population. This chapter provides an overview of disorders of fluid balance, electrolyte homeostasis and kidney function associated with neonatal encephalopathy and therapeutic hypothermia. Recommendations for fluid and electrolyte management based upon published literature and authors’ opinions are provided.

The influence of hyperbilirubinemia on indexes of kidney function in neonates.

To study the influence of hyperbilirubinemia on indexes of neonatal kidney function. A prospective cohort study was conducted September 2019 to March 2020 in Neonatology Department of Xuzhou Central Hospital. Neonates with gestational age ≥ 35 weeks and aged ≤ 7 days were included and divided into mild, moderate, and severe groups according to total serum bilirubin level. Epidemiologic and demographic data and daily urine output were recorded. Total serum bilirubin, serum creatinine, serum cystatin C, serum neutrophil gelatinase-associated lipocalin (NGAL), urine NGAL, and kidney injury molecule-1 were tested before and 12~18 h after phototherapy. Parameters of kidney function were compared between groups. Fifty-three, 52, and 49 neonates were included in the mild, moderate, and severe groups, respectively. Urine NGAL was higher in severe (1.36 ± 0.24 μg/L) compared to moderate (1.22 ± 0.19 μg/L) and mild groups (1.16 ± 0.19 μg/L), and differences were statistically significant (P = 0.004 and < 0.001, respectively). Urine NGAL was not significantly different between moderate and mild groups (P > 0.05). No significant differences in other kidney function indexes were observed between the three groups (all P > 0.05). Significant reduction in urine NGAL levels 12~18 h after stopping phototherapy was found in severe group ((1.17 ± 0.28) μg/L vs. (1.35 ± 0.23) μg/L, P < 0.001). Urine NGAL positively correlated with total serum bilirubin (r = 0.575, P < 0.001). Among all cases, neither serum creatinine nor daily urine output met neonatal acute kidney injury diagnostic criteria. Severe hyperbilirubinemia may temporarily impair renal tubular reabsorption functions in full-term and near-term neonates, which is likely reversible. However, it has little effect on glomerular filtration function. A higher resolution version of the Graphical abstract is available as Supplementary information.

Relationship Between Body Weight Serum Creatinine, Cystatin C in Early Prediction of Acute Kidney Injury in Critically Ill Neonates.

Introduction: Neonatal Acute Kidney Injury (AKI) become a serious problem in critically ill neonates, serum creatinine level (SCr) which used to detect glomerular filtration rate has a lot of pitfalls, serum cystatin C level (SCys C) is more accurate and with better advantages. Aim of the Study: Our aim is to early detection of acute kidney injury in neonates especially low birth weight before any damage occur. Methods: This cross sectional study was conducted on 50 critically ill neonates randomly selected from the Neonatal Intensive Care Unit, Pediatric Department, in our University Hospitals. Detailed history, clinical examination, appropriate investigations were done. Plasma level of serum Cystatin C as well as SCr were done at the 1st and 3rd day of admission. Results: Fifty infants were recruited into this study out of which complete data were available, the study was conducted on both term and preterm infants. The mean SCr level in AK I group in the 1st and 3rd day respectively was 0.56 and1.13, while serum cystatin level was 31.86 and48.67 respectively with significant P Value P ≤ 0.001, SCr had a significant correlation with weight (r = 0 .992; P < 0.001), whereas serum CysC had no correlation with the infant’s weight (r = 0.021; P = 0.884). There was no statistically significant difference in SCr and CysC between male and female infants. Conclusion: Serum Cystatin C is an earlier detector for AKI in critically ill neonates and un like serum creatinine has no significant correlation with birth weight.

A Cohort Study of Acute Kidney Injury in Egyptian Neonates; Etiology, Risk Factors, Diagnosis and Three Months Follow Up.

Introduction: Acute kidney injury (AKI) is a major contributor of neonatal mortality and morbidity. Understanding the different anatomy of the neonatal kidney could help physician understand pathology of AKI and consequently could treat it efficiently. Aim of the study: This one year duration prospective Cohort study involved twenty seven admitted neonates who had acute kidney injury (AKI). Methods: Laboratory and radiologic diagnosis of AKI, further AKIN and pRIFLE classification and follow up after one and three months. Results: AKI had an incidence of 1.35%, mainly in full-term (59%). Hypertension was presented in full-term (75%) and preterm (45.5%). Hematuria presented by 18.8% (full-term) and 27.3% (preterm). Proteinuria occurred in full-term (46.7%) and preterm (36.4%). Urinary tract infection was more among (45.5%) preterm than full term (25%). Oliguric AKI was found in full term (68.8%) and preterm (72.7%). Anuric AKI present in full-term (31.1%) and preterm (9.1%). Post renal AKI were present 18.8 %( full term) and 9.1 %( preterm). Perinatal asphyxia (18.8%) and sepsis (27.3%) were the most common risk factor. Both full-term (37.5%) and preterm (18.2%) needed peritoneal dialysis. Ultrasonography showed bilateral Grade 2 (50%) and 1(25%) nephropathy and bilateral back pressure (18%). pRIFLE was inversely correlate with age and urine output and positively correlated with hypertension at baseline. At one month; 43.8% full-term, 18.2 % preterm were found hypertensive, 18.8% fullterm had proteinuria, pRIFLE was inversely correlated with urine output and proteinuria and eCCL was significantly improved after one month in both preterm and full-term. At three month, chronic kidney disease was 12.5% and 9.1% in full-term and preterm respectively. Total recovery was higher in preterm neonates than in full-term ones. Conclusion: Sepsis and asphyxia are considered the most common causes of AKI. Limitation: A longer follow up is mandatory. Further follow up studies of AKI in preterm neonates are mandatory.

Renal insufficiency in children born preterm: examining the role of neonatal acute kidney injury.

To identify the prevalence of renal insufficiency (RI) in children with a history of prematurity and acute kidney injury (AKI). This prospective cohort study evaluated renal function in children born preterm at 5-9 years of age. Univariable analyses compared perinatal and follow-up data from subjects with and without AKI history, and with and without current RI. Regression analyses were attempted to model RI as a function of AKI and other clinical risk factors. Fifteen of 43 (35%) participants had previously undiagnosed RI. Only children with no AKI history or neonatal stage 1 AKI presented for follow-up. Children born preterm with a history of stage 1 AKI had higher serum creatinine (sCr) at follow-up, but were not more likely to have RI compared to children without stage 1 AKI history (RI prevalence 30% and 36% in AKI and non-AKI group, respectively). The high prevalence of RI in this preterm cohort at middle childhood follow-up highlights the need for routine kidney health assessments in this population. Large multicenter studies are needed to further characterize the impact of premature birth and mild AKI on renal function throughout childhood.

Neonatal acute kidney injury risk stratification score: STARZ study.

Neonates admitted in the neonatal intensive care unit are vulnerable to acute kidney injury leading to worse outcomes. It is important to identify "at-risk" neonates for early preventive measures. The study was a multicenter, national, prospective cohort study done in 11 centers in India. A multivariable logistic regression technique with step-wise backward elimination method was used, and a "Risk Prediction Scoring" was devised [the STARZ score]. The neonates with admission in the NICU within <25.5 h of birth, requirement of positive pressure ventilation in the delivery room, <28 weeks gestational age, sepsis, significant cardiac disease, urine output <1.32 ml/kg/h or serum creatinine ≥0.98 mg/dl during the first 12 h post admission, use of nephrotoxic drugs, use of furosemide, or use of inotrope had a significantly higher risk of AKI at 7 days post admission in the multivariate logistic regression model. This scoring model had a sensitivity of 92.8%, specificity of 87.4% positive predictive value of 80.5%, negative predictive value of 95.6%, and accuracy of 89.4%. The STARZ neonatal score serves to rapidly and quantitatively determine the risk of AKI in neonates admitted to the neonatal intensive care unit. The STARZ neonatal score serves to rapidly and quantitatively determine the risk of AKI in neonates admitted to the neonatal intensive care unit. These neonates with a higher risk stratification score need intense monitoring and daily kidney function assessment. With this intensification of research in the field of AKI risk stratification prediction, there is hope that we will be able to decrease morbidity and mortality associated with AKI in this population.

Expert consensus on continuous blood purification in the treatment of neonatal acute kidney injury

Expert consensus on continuous blood purification in the treatment of neonatal acute kidney injury

Interpretation of expert consensus on continuous blood purification in the treatment of neonatal acute kidney injury

我国新生儿行连续性血液净化治疗需求不断增高，但相较于成人，新生儿进行连续性血液净化治疗面临的挑战更大。中华医学会儿科学分会新生儿学组组织撰写了“连续性血液净化治疗新生儿急性肾损伤专家共识”，旨在逐步规范新生儿急性肾损伤中的连续性血液净化治疗技术，改善患儿预后，减少并发症。本文对此共识进行解读。.

Sonographical evaluation of normal liver, spleen, and kidney dimensions in neonates, infants, and children upto 5 years of age at tertiary care teaching hospital in Gujarat

Objective: The objective of this study was to determine the normal range of dimensions for the liver, spleen, and kidney in healthy neonates, infants, and children upto 5 years in Gujarat. Subjects and Methods: This cross-sectional, prospective study involved 663 Paediatric participants (307 girls and 383 boys) with normal physical or sonographic findings who were examined because of problems unrelated to the measured organs. The participants were 1 day to 5 years old. All measured organs were sonographically normal. At least two dimensions were obtained for each liver, spleen, and kidney. Relationships of the dimensions of these organs with sex and age were investigated. Suggested limits of normal dimensions were defined.Results: A 663 paediatric participants of which 369 (55.65%) were male and 294 (44.34%) were female participants with male to female ratio of (1.25:1). Maximum number of participants were neonates. Average size of liver, spleen and kidney found was 58.33 mm, 44.44mm, 36 x 18 mm (R),40 x 21 mm (L) respectively. Conclusion: Determination of pathologic changes in size of the liver, spleen, and kidney necessitates knowing the normal range of dimensions for these organs in healthy neonates, infants, and young children. The study provides the normal values of liver, spleen and kidney size by ultrasonography in healthy Indian children.