Acute kidney injury in necrotizing enterocolitis predicts mortality

Area of Science:

• Neonatal Medicine
• Pediatric Nephrology
• Critical Care

Background:

• Necrotizing enterocolitis (NEC) presents a significant challenge in neonatal morbidity and mortality.
• Acute kidney injury (AKI) is a known factor that worsens survival rates in critically ill neonates.
• This study is the first to investigate the prevalence and outcomes of AKI in neonatal NEC.

Purpose of the Study:

• To determine the prevalence of AKI in neonates diagnosed with NEC.
• To evaluate the impact of AKI on in-hospital mortality, hospital length of stay (LOS), and surgical intervention in neonatal NEC patients.

Main Methods:

• A single-center retrospective chart review was conducted on 181 neonates treated for NEC between 2003 and 2015.
• AKI was defined using neonatal modified KDIGO criteria based on serum creatinine (SCr) levels.
• Primary outcome was in-hospital mortality; secondary outcomes included LOS and surgical intervention.

Main Results:

• AKI was present in 54% of neonates with NEC, with varying stages of severity, including 5 requiring dialysis.
• Neonates with AKI exhibited significantly higher in-hospital mortality (44% vs. 25.6%, p=0.008) and increased odds of death (HR 2.4, p=0.009).
• While AKI did not significantly impact LOS in survivors, 27.9% of all patients required surgery.

Conclusions:

• AKI is highly prevalent in neonatal NEC, affecting over half of the patients.
• AKI is associated with a more than two-fold increase in mortality among neonates with NEC.
• These findings underscore the critical need for early AKI recognition and intervention in NEC management.