Acute kidney injury in newborns with necrotizing enterocolitis: risk factors and mortality

Both necrotizing enterocolitis and acute kidney injury are tightly related conditions, which independently increase mortality in newborns. Necrotizing enterocolitis is an inflammatory disease with a systemic repercussion that leads to inflammatory kidney changes predisposing to renal damage.

This study assessed risk factors for the development of acute kidney injury in patients diagnosed with necrotizing enterocolitis and compared mortality between patients with or without acute kidney injury. Thirty-nine patients with the diagnosis of necrotizing enterocolitis were included, regardless of the gestational age.

Of 39 patients, 38.5% developed acute kidney injury. Survival showed to be significantly lower in patients with acute kidney injury (54.4 days) when compared to newborns without acute kidney injury (76.22 days; p = 0.014). Mortality in patients with acute kidney injury was 46.7%, increasing up to 62.5% with severe kidney damage. The hazard ratio for mortality was 4.708 for acute kidney injury (p = 0.025). The severity of enterocolitis showed to be an independent risk factor in developing acute kidney injury and severe kidney injury (odds ratio [OR] = 1.841, p = 0.034 and OR = 1.917, p = 0.027, respectively).

Newborns with necrotizing enterocolitis should be evaluated for early recognition of acute kidney injury. Prospective studies with a higher number of patients are needed to identify modifiable risk factors to impact in the prevention of these conditions.