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Neonatal Acute Kidney Injury
David T Selewski1, Jennifer R Charlton2, Jennifer G Jetton3
1Division of Nephrology, Department of Pediatrics and Communicable Diseases, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan;
Pediatrics
|July 15, 2015
Summary
Neonatal acute kidney injury (AKI) is common and linked to poor outcomes. This review details its unique physiology, risk factors, and management, advocating for standardized criteria and long-term follow-up for vulnerable infants.
Area of Science:
- Neonatology
- Nephrology
- Pediatric Critical Care
Background:
- Neonatal acute kidney injury (AKI) is increasingly recognized as a significant clinical problem.
- Existing research suggests a high prevalence and association with adverse outcomes in neonates.
- There is a need for a comprehensive understanding of neonatal AKI, distinct from adult forms.
Purpose of the Study:
- To provide a state-of-the-art review of neonatal AKI.
- To highlight unique aspects of neonatal renal physiology, risk factors, epidemiology, and outcomes.
- To propose standardized definition and management strategies for neonatal AKI.
Main Methods:
- Review of current literature on neonatal AKI.
- Description of neonatal renal physiology and age-related changes.
- Presentation and rationale for the neonatal modified Kidney Diseases: Improving Global Outcomes (KDIGO) AKI criteria.
Main Results:
- Neonatal AKI is common, particularly in high-risk populations like premature infants and those with perinatal asphyxia.
- Specific patient groups requiring closer surveillance are identified (e.g., <1500g, ECMO, cardiac surgery).
- Recommendations for evaluation, treatment (medications, RRT), and long-term follow-up are provided.
Conclusions:
- Standardized definitions and criteria (neonatal modified KDIGO) are crucial for consistent diagnosis and research.
- Early identification and management of neonatal AKI are essential to improve short- and long-term outcomes.
- Further research is needed, supported by initiatives like the Neonatal Kidney Collaborative.
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