Temporal Trends of Acute Kidney Injury and Associated Risk Exposures in Extremely Preterm Infants. Issue 8 (August 2021)

• Record Type: Journal Article
• Authors: Chen, Chih-Chia; Lin, Yung-Chieh; Wang, Shan-Tair; Huang, Chao-Ching
• Other Names: author non-byline.; Li-Wen Chen author non-byline.; Yung-Chieh Lin author non-byline.; Wen-Hao Yu author non-byline.; Chih-Chia Chen author non-byline.; Yen-Ju Chen author non-byline.; Chia-Lin Koh author non-byline.; Yi-Shan Tsai author non-byline.; Ray-Bing Chen author non-byline.; Kuo-Jung Lee author non-byline.; Chih-Chung Hsu author non-byline.; Chi‐Hsiang Chu author non-byline.; Chiou-Feng Lin author non-byline.; Cheng-Chin Kuo author non-byline.
• Is Part Of: Clinical journal of the American Society of Nephrology. Volume 16:Issue 8(2021)
• Page Start: 1169
• Page End: 1177
• Publication Date: 2021-08
• Subjects: acute kidney injury -- care practice -- extremely preterm infants
• DOI: 10.2215/CJN.19301220
• Languages: English
• ISSNs: 1555-9041

Abstract

Visual Abstract: Abstract : Background and objectives: Neonatal AKI in the preterm population is an under-recognized morbidity. Detecting AKI in preterm infants is important for their long-term kidney health. We aimed to examine the yearly trends of incidence and the related morbidities and care practices affecting the occurrence of neonatal AKI in extremely preterm (gestational age <29 weeks) and very preterm (gestational age 29–32 weeks) infants. Design, setting, participants, & measurements: The trends and the related risk factors and care practices of AKI were examined in the extremely preterm ( n =434) and very preterm ( n =257) infants who were admitted within 14 days after birth from 2005 to 2018 to the University Hospital and had at least two serum creatinine measurements during hospitalization. We defined AKI as a serum creatinine rise of 0.3 mg/dl or more within 48 hours or a 1.5-fold increase within 7 days. Results: The extremely preterm group had a three-fold higher incidence of AKI (30% versus 10%) than the very preterm group. Among preterm infants with AKI, 92% had one episode of AKI, and 45% experienced stage 2 or 3 AKI; the mean duration of AKI was 12±9 days. Across the 14-year period, the crude incidence of AKI declined markedly from 56% to 17% in the extremely preterm group and from 23% to 6% in the very preterm group. After adjustment, a significant decline of AKI incidence was still observed in the extremely preterm group. The declining AKI in the extremely preterm infants was related to the trends of decreasing incidences of neonatal transfer, prolonged aminoglycoside exposure, prophylactic use of nonsteroidal anti-inflammatory drugs, and sepsis. Conclusions: We observed a declining trend in the incidence of neonatal AKI among extremely preterm infants from 2005 to 2018, which may be related to improvement of care practices.