Temporal Trends of Acute Kidney Injury and Associated Risk Exposures in Extremely Preterm Infants

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Chih-Chia Chen1,2, Yung-Chieh Lin1,2, Shan-Tair Wang3,4

  • 1Graduate Institute of Clinical Medicine, College of Medicine, National Cheng-Kung University, Tainan, Taiwan.

Clinical Journal of the American Society of Nephrology : CJASN
|August 5, 2021
PubMed

Insights

Neonatal acute kidney injury (AKI) incidence declined significantly in extremely preterm infants due to improved care practices. This trend highlights advancements in managing this vulnerable population and reducing long-term kidney health risks.

Area of Science:

  • Neonatal Nephrology
  • Pediatric Critical Care Medicine
  • Clinical Epidemiology

Background:

  • Neonatal acute kidney injury (AKI) is an under-recognized condition in preterm infants.
  • Early detection and management of AKI are crucial for long-term kidney health in this population.
  • Understanding trends in AKI incidence and associated factors is vital for improving neonatal care.

Purpose of the Study:

  • To examine yearly trends in the incidence of neonatal AKI.
  • To identify related morbidities and care practices influencing AKI occurrence in extremely preterm and very preterm infants.
  • To analyze changes in AKI incidence over a 14-year period.

Main Methods:

  • Retrospective analysis of extremely preterm (gestational age <29 weeks) and very preterm (gestational age 29-32 weeks) infants admitted between 2005 and 2018.
  • Inclusion criteria: admission within 14 days of birth and at least two serum creatinine measurements.
  • AKI definition: serum creatinine rise of ≥0.3 mg/dL within 48 hours or a 1.5-fold increase within 7 days.

Main Results:

  • The incidence of AKI was significantly higher in extremely preterm infants (30%) compared to very preterm infants (10%).
  • Overall AKI incidence markedly declined from 56% to 17% in extremely preterm and 23% to 6% in very preterm infants over the study period.
  • Declining AKI trends in extremely preterm infants correlated with reduced neonatal transfer, prolonged aminoglycoside exposure, prophylactic NSAID use, and sepsis.

Conclusions:

  • A significant declining trend in neonatal AKI incidence was observed in extremely preterm infants from 2005 to 2018.
  • Improvements in care practices, including reduced aminoglycoside use and sepsis management, likely contributed to the observed decline.
  • Continued monitoring and research into care practices are essential for further reducing AKI in preterm neonates.
Abstract

Keywords:
acute kidney injurycare practiceextremely preterm infants

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