Clinical impact of severe acute kidney injury on post-operative and brain injury outcomes in preterm infants following surgical necrotizing enterocolitis. (12th December 2022)

• Record Type: Journal Article
• Authors: Garg, Parvesh Mohan; Paschal, Jaslyn L.; Zhang, Mengna; Pippins, Melissa; Taylor, Charlotte; Sanderson, Keia; Reddy, Kartik; Askenazi, David; Padbury, James F.; Hillegass, William B.
• Is Part Of: Journal of maternal-fetal & neonatal medicine. Volume 35:Number 25(2022)
• Page Start: 10124
• Page End: 10136
• Publication Date: 2022-12-12
• Subjects: Acute kidney injury -- brain injury -- postoperative outcomes -- preterm infants; Obstetrics -- Periodicals; Perinatology -- Periodicals; Infants (Newborn) -- Diseases -- Periodicals; Neonatology -- Periodicals; 618.2
• DOI: 10.1080/14767058.2022.2121917
• Languages: English
• ISSNs: 1476-7058

Abstract

Abstract: Background: To evaluate post-operative outcomes and white matter injury (WMI) using brain MRI at term equivalent in neonates with and without severe acute kidney injury (AKI) following surgical necrotizing enterocolitis (NEC). Methods: A retrospective cohort study comparing neonates with severe (Stage 2/3) vs. other (no AKI/Stage 1) AKI using KDIGO classification with multivariable models assessing this association in the context of multiple systemic comorbidities. Results: Of 103 neonates with surgical NEC, 60 (58%) had severe AKI. Those with severe AKI had lower birth weight (BW; 715 vs. 950 g; p = .023), more frequently treated with indomethacin (18.3 vs. 2.4%); p = .014), higher CRP levels at 24 h after NEC onset (14.4 [6.4–19.8] vs . 4.8 [1.6–13.4]; p = .005), higher presence of cholestasis (73.3 vs. 51.2%); p = .023), later age of NEC onset (14 vs. 7 d); p = .004), longer length of bowel resected (14.9 vs. 4.3 cm); p = .011), longer post-operative ileus days (14 vs. 9 d); p < .001), longer post-operative days at starting enteral feedings (15 vs . 10 d; p < .001), longer days of attainment of full enteral feedings (75 vs . 44.5 d; p = .008) and longer length of stay (140.5 vs . 94 d; p = .028) compared to those without severe AKI. Compared to infants without AKI by serum creatinine, those with AKI had significantly more cases of white matter abnormality (WMA; 90 vs . 36.6%; p < .001) and retinopathy of prematurity (63.9 vs. 35.3%; p = .017). In addition, the presence of AKI Stage 2 and 3 by serum creatinine was independently associated with higher odds of sustaining severe WMI level on an ordinal scale (OR = 6.2; 95% CI = (1.1–35.5); p = .041). Conclusions: Neonates with severe AKI following surgical NEC were more likely to experience longer post-operative morbidity and higher WMI by MRI at term.