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Published on: August 25, 2022
Neonatal Acute Kidney Injury and the Risk of Intraventricular Hemorrhage in the Very Low Birth Weight Infant
Christine Stoops1, Brian Sims, Russell Griffin
1Division of Neonatology, University of Alabama at Birmingham, Birmingham, Ala., USA.
Insights
Acute kidney injury (AKI) in premature infants is linked to a higher risk of severe intraventricular hemorrhage (IVH). This finding highlights the kidney's critical role in neonatal brain development and complications.
Area of Science:
- Neonatal Medicine
- Pediatric Nephrology
- Neonatal Neurology
Background:
- Premature infants face significant risks of comorbid conditions, impacting survival.
- The kidney's role in multiorgan dysfunction, especially concerning intraventricular hemorrhage (IVH), remains unclear.
Purpose of the Study:
- To investigate the association between acute kidney injury (AKI) and the risk of IVH in premature infants.
- To determine if AKI increases IVH risk independently of gestational age and other known risk factors.
Main Methods:
- Prospective cohort study of 125 infants with birth weight ≤1,200 g and/or gestational age ≤31 weeks.
- AKI diagnosed using KDIGO criteria, excluding urine output due to common nonoliguria in this population.
- IVH assessed via serial head ultrasounds.
Main Results:
- Infants with AKI showed a trend towards higher IVH rates (40% vs. 26.5%, p=0.1).
- AKI was significantly associated with higher likelihood of stage 2 or higher IVH (33.3% vs. 7.3%, p<0.01).
- AKI increased the risk of grade ≥2 IVH (HR 3.55) and grade ≥3 IVH (HR 4.34), even after controlling for covariates.
Conclusions:
- While overall AKI-IVH association was not significant, AKI elevates the risk for moderate to severe IVH in premature infants.
- Findings suggest AKI is an independent risk factor for significant IVH, warranting further investigation.
- Larger studies are needed to confirm these findings and explore other clinical variables.
Abstract:
Despite improvements in survival of premature infants, many have comorbid conditions. The role of the kidney in multiorgan dysfunction is unclear, particularly in regard to intraventricular hemorrhage (IVH). We hypothesized that infants diagnosed with acute kidney injury (AKI) have an increased risk of IVH independent of gestational age (GA) and other variables associated with both comorbidities. This prospective cohort study consisted of 125 infants with a birth weight ≤1,200 g and/or GA ≤31 weeks. A definition of AKI was used from KDIGO, not including urine output as nonoliguria is common in this population. IVH was based on serial head ultrasounds. Neonates with AKI had a higher trend towards having IVH compared to those without [14/35 (40%) vs. 22/83 (26.5%), p = 0.1]. Infants with AKI were more likely to have stage 2 IVH or higher than those without AKI [12/36 (33.3%) vs. 6/82 (7.3%); p < 0.01]. AKI was associated with a 3.6-fold increased risk of a grade 2 or higher IVH [hazard ratio (HR) 3.55, 95% confidence interval (CI) 1.39-9.07] and over 4-fold increase in risk of a grade 3 or higher IVH (HR 4.34, 95% CI 1.43-13.21). While there was no association between AKI and IVH overall, those with AKI had a higher hazard ratio to develop a grade 2 or higher IVH even when controlling for birth weight, antenatal steroid use, and 5-min Apgar score. Future studies are indicated to expand sample size and to control for other clinical variables that could be associated with both AKI and IVH.
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