Related Experiment Video
Updated: Apr 23, 2026
Noninvasive and Invasive Renal Hypoxia Monitoring in a Porcine Model of Hemorrhagic Shock
Published on: October 28, 2022
Recognition and reporting of AKI in very low birth weight infants
J Bryan Carmody1, Jonathan R Swanson2, Erika T Rhone3
1Department of Pediatrics, Division of Nephrology, Eastern Virginia Medical School, Norfolk, Virginia; and.
Insights
Acute kidney injury (AKI) affects 40% of very low birth weight infants, particularly the most premature and ill. Diagnosis reporting and nephrologist referrals are infrequent, indicating a need for improved care for these vulnerable infants.
Area of Science:
- Neonatal intensive care
- Pediatric nephrology
- Critical care medicine
Background:
- Acute kidney injury (AKI) is linked to poor short-term outcomes and increased long-term risk of chronic kidney disease (CKD).
- Understanding AKI prevalence in very low birth weight (VLBW) infants is crucial for timely intervention and management.
- Current diagnostic and follow-up practices for AKI in VLBW infants require evaluation.
Purpose of the Study:
- To determine the prevalence of AKI in VLBW infants using a current definition.
- To assess the frequency of AKI diagnosis reporting in discharge summaries.
- To evaluate the rate of referral to pediatric nephrologists for AKI follow-up.
Main Methods:
- Retrospective review of VLBW infants admitted to a level IV NICU (2008-2011).
- AKI classification based on the Kidney Disease: Improving Global Outcomes (KDIGO) definition, adapted for serum creatinine.
- Analysis of risk factors, mortality, length of stay, and follow-up care.
Main Results:
- AKI occurred in 39.8% of 455 VLBW infants; 16.5% had multiple episodes.
- Higher scores on the Clinical Risk Index for Babies (CRIB) and lower gestational age (<28 weeks) were significantly associated with AKI.
- AKI was linked to increased mortality (OR 4.0) and longer hospital stays (11.7 days), independent of other factors.
- AKI was documented in discharge summaries for only 13.5% of survivors; no infants were referred for nephrology follow-up.
Conclusions:
- AKI is highly prevalent in VLBW infants, especially the most premature and critically ill.
- Under-recognition and infrequent follow-up care for AKI in VLBW infants highlight significant quality improvement opportunities.
- Improved documentation and systematic referral to pediatric nephrology are needed for AKI survivors.
Background And Objectives:
AKI is associated with both increased short-term morbidity and mortality and greater long-term risk for CKD. This study determined the prevalence of AKI among very low birth weight infants using a modern study definition, evaluated the frequency of AKI diagnosis reporting in the discharge summary, and determined whether infants were referred to a pediatric nephrologist for AKI follow-up.
Design, Setting, Participants, & Measurements:
Records of very low birth weight infants admitted to a level IV neonatal intensive care unit from 2008 to 2011 were reviewed. AKI was classified using the Kidney Disease: Improving Global Outcomes definition modified to include only serum creatinine.
Results:
AKI occurred in 39.8% of 455 infants; 75 (16.5%) infants experienced multiple episodes of AKI, and 8 (2%) infants were discharged with an abnormal last creatinine. Updated clinical risk index for babies score >10 (odds ratio, 12.9; 95% confidence interval, 7.8 to 21.4) and gestational age <28 weeks (odds ratio, 10.6; 95% confidence interval, 6.8 to 16.7) were strongly associated with AKI in univariate analyses. AKI was associated with increased mortality (odds ratio, 4.0; 95% confidence interval, 1.4 to 11.5) and length of stay (11.7 hospital days; 95% confidence interval, 5.1 to 18.4), even after accounting for gestational age, birth weight, and updated clinical risk index for babies score. AKI was recorded in the discharge summary for only 13.5% of AKI survivors. No infants were referred to a nephrologist for AKI follow-up.
Conclusions:
AKI occurred in 40% of very low birth weight infants and was concentrated in the most premature and severely ill infants. One in six infants experienced multiple episodes of AKI, and a small number of infants was discharged with an elevated serum creatinine. Reporting a history of AKI in the discharge summary occurred infrequently, and referral to a nephrologist for AKI follow-up did not occur, highlighting areas for quality improvement.
Related Concept Videos
01:22Acute Kidney Injury I: Introduction
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:20Acute Kidney Injury V: Interprofessional Care
01:22Acute Kidney Injury VI: Nursing Management
01:29Acute Kidney Injury III: Clinical Manifestations
01:29Acute Kidney Injury II: Pathophysiology