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Perioperative Neonatal Acute Kidney Injury Is Common: Risk Factors for Poor Outcomes
Tahagod H Mohamed1,2, Christian Mpody3, Olubukola Nafiu3
1The Division of Nephrology and Hypertension, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio.
American Journal of Perinatology
|August 29, 2023
Summary
Perioperative acute kidney injury (AKI) is common in neonates undergoing noncardiac surgery. Risk factors for AKI and mortality include low birth weight and specific comorbidities, highlighting the need for kidney function surveillance.
Area of Science:
- Pediatric Nephrology
- Neonatal Surgery
- Critical Care Medicine
Background:
- Perioperative acute kidney injury (AKI) is a known complication with significant patient outcome implications.
- While studied in children and neonates with cardiac disease, less is known about AKI in neonates undergoing noncardiac surgeries.
- Existing research suggests a potential for higher AKI prevalence in neonates compared to older children undergoing noncardiac procedures.
Purpose of the Study:
- To determine the prevalence of perioperative AKI in neonates undergoing noncardiac surgeries.
- To identify neonatal characteristics and comorbidities that increase the risk of perioperative AKI.
- To outline the risk factors associated with hospital mortality in neonates with perioperative AKI.
Main Methods:
- Retrospective analysis of neonates (≤28 days old) undergoing inpatient noncardiac surgery.
- Data collected from 46 U.S. children's hospitals between 2016 and 2021.
- AKI diagnosis based on International Classification of Diseases (ICD) codes; comorbidities identified via ICD-9 and ICD-10 codes.
Main Results:
- Perioperative AKI was observed in 10% of neonates undergoing noncardiac surgery.
- Associated comorbidities included metabolic, hematologic/immunologic, cardiovascular, and renal disorders.
- Increased mortality risk was linked to low birth weight, and hematologic, renal, and respiratory comorbidities.
Conclusions:
- Perioperative AKI is a frequent occurrence in neonates undergoing noncardiac surgical procedures.
- Neonates with specific high-risk comorbidities require vigilant kidney function monitoring during the perioperative period.
- Findings can guide tailored neonatal perioperative care to improve outcomes.
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