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Acute kidney injury post-abdominal surgery in infants: implications for prevention and management

Minh Dien Duong1, Silvia Kwak2, Naina Bagrodia3

  • 1Pediatric Nephrology, Norton Children's Hospital, University of Louisville, School of Medicine, Louisville, KY, United States.

Frontiers in Pediatrics
|May 8, 2023
PubMed

Insights

Acute kidney injury (AKI) in infants after abdominal surgery is common and linked to long-term health issues. Early detection and management are crucial for better outcomes in these vulnerable patients.

Area of Science:

  • Pediatric Nephrology
  • Critical Care Medicine
  • Surgical Outcomes

Background:

  • Acute kidney injury (AKI) is a frequent complication in critically ill infants, often leading to chronic kidney disease and hypertension.
  • While AKI after cardiothoracic surgery is well-documented, data on AKI following abdominal surgery in infants is limited.
  • Understanding AKI in this specific surgical context is vital for improving infant health outcomes.

Purpose of the Study:

  • To review the epidemiology of postoperative AKI in infants undergoing abdominal surgery.
  • To identify specific risk factors and outcomes associated with abdominal surgery-related AKI.
  • To suggest effective management and prevention strategies for AKI in this population.

Main Methods:

  • Literature review focusing on pediatric abdominal surgery and postoperative AKI.
  • Analysis of risk factors including prematurity, sepsis, operative factors, and specific diagnoses like necrotizing enterocolitis.
  • Discussion of diagnostic markers and monitoring parameters for AKI.

Main Results:

  • Infants undergoing intraabdominal surgeries face unique AKI risks.
  • Factors like prematurity, sepsis, prolonged/emergent procedures, and necrotizing enterocolitis significantly increase AKI risk.
  • Elevated urinary neutrophil gelatinase-associated lipocalin (NGAL) 24 hours post-procedure may aid early AKI prediction.

Conclusions:

  • AKI following abdominal surgery in infants requires vigilant monitoring and proactive management.
  • Key strategies include close surveillance of urine output, creatinine, and fluid balance.
  • Preventive measures involve identifying high-risk infants, avoiding nephrotoxins, maintaining hemodynamic stability, and early AKI detection.

Keywords:
AKI (acute kidney injury)abdominal surgeriesneonatal AKIpostoperative managementpreoperative consideration

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