Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate
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ORIGINAL ARTICLE
Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate David J. Askenazi & Rajesh Koralkar & Hayden E. Hundley & Angela Montesanti & Neha Patil & Namasivayam Ambalavanan
Received: 29 August 2012 / Revised: 29 October 2012 / Accepted: 2 November 2012 / Published online: 9 December 2012 # IPNA 2012
Abstract Background Acute kidney injury (AKI) is common and portends mortality in several neonatal cohorts. Fluid overload is independently associated with poor outcomes in children and adults but has not been extensively studied in neonates. Methods Between February 2010 and May 2011, we followed 58 neonates who met the following criteria: birth weight >2,000 g, gestational age ≥34 weeks, 5-min Apgar ≤7, and parental consent. Serum creatinine (SCr) was measured daily for first 4 days of life. AKI was defined as a rise in SCr of > 0.3 mg/dl or persistent SCr above 1.5 mg/dl. Results AKI was present in 9/58 (15.6 %) neonates and was associated with higher birth weight, being male, lower 5-min Apgar scores, lower cord pH, delivery room intubation, and absence of maternal pre-eclampsia. Percent weight accumulation at day 3 of life was higher in those with AKI [median= 8.2, interquartile range (IQR)=4.4–21.6)] than without AKI D. J. Askenazi : N. Patil : N. Ambalavanan Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA R. Koralkar Department of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA H. E. Hundley University of South Alabama, College of Medicine, Birmingham, AL, USA A. Montesanti Georgia State University Institute of Public Health, Center for Healthy Development, Birmingham, AL, USA D. J. Askenazi (*) Department of Pediatrics, Division of Nephrology, University of Alabama at Birmingham, 1600 7th Ave South, ACC 516, Birmingham, AL 35233, USA e-mail: [email protected]
(median=−4 (IQR=−6.5 to 0.0) (p2,000 g, GA≥34 weeks, 5-min Apgar score ≤7, and parental informed consent. Infants were excluded if they did not survive to 24 h of life, had known congenital abnormality of the kidney, or were undergoing whole-body hypothermia for severe asphyxia. The University of Alabama at Birmingham’s Institutional Review Board approved the study. Study design Enrolled infants were followed prospectively from the time of birth until 36 weeks postmenstrual age (PMA) or hospital discharge, whichever occurred first. Serum creatinine (SCr) was obtained daily during the first 4 days of life and measured using the Jaffe reaction. AKI was defined as an acute rise in SCr of at least 0.3 mg/dl within 48 h [stage 1 of the Acute Kidney Injury Network (AKIN) definition]. Each day’s SCr was compared with the lowest previous SCr measured. Those with a persistent SCr≥1.5 mg/dl for at least 3 days after birth were also considered to have AKI. The degree of fluid accumulation was assessed by determining the percentage weight change at 3 days of life. Infants who were discharge home or were in stable good/stable condition at 36 weeks
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