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Updated: Jan 17, 2026

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Published on: August 9, 2013
The overlooked subgroup: preterm neonates with elevated serum creatinine outside neonatal AKI criteria
Chih-Chia Chen1,2, Yung-Chieh Lin2, Chao-Ching Huang3,4
1Graduate Institute of Clinical Medicine, College of Medicine, National Cheng-Kung University, Tainan, Taiwan, ROC.
Background:
To characterize risks and outcomes of preterm neonates with elevated serum creatinine (SCr) not meeting acute kidney injury (AKI) criteria.
Methods:
This cohort study included neonates <31 weeks' gestation admitted to a university hospital. Elevated SCr was defined as exceeding the 95th percentile for postnatal age without meeting standard AKI criteria in neonates <28 or 28-30 weeks. Perinatal/neonatal risks and discharge outcomes were compared among elevated SCr, SCr-AKI, and no SCr-AKI subgroups.
Results:
Among 810 infants, 156 had SCr-AKI, 623 had no SCr-AKI, and 31 had elevated SCr. Compared to no SCr-AKI, the elevated SCr subgroup had lower birthweight, higher rates of small-for-gestational-age, respiratory distress, hemodynamic instability, prolonged invasive ventilation, lower anthropometric z-scores, and higher mortality, despite similar gestational age. Compared to SCr-AKI, they had higher gestational age and higher rates of small-for-gestational-age, with similar mortality. Adjusted models showed elevated SCr (adjusted relative risk [aRR], 3.74) and SCr-AKI (aRR, 3.95) predicted higher mortality versus no SCr-AKI.
Conclusion:
Gestational age-specific SCr references are critical for identifying preterm neonates with elevated SCr levels outside AKI criteria, who face neonatal risks and distinct mortality outcomes.
Impact Statement:
The risks and outcomes of preterm neonates with elevated serum creatinine (SCr) levels that do not meet Kidney Disease: Improving Global Outcomes (KDIGO) acute kidney injury (AKI) criteria require further investigation. These neonates have distinct exposure profiles compared to those with KDIGO SCr-AKI and a poorer prognosis than those without SCr-AKI. They also have higher mortality than neonates without SCr-AKI. Our findings highlight the importance of gestational age-specific SCr reference values in neonatal care to better identify at-risk preterm infants beyond KDIGO criteria, enabling early intervention and improved outcomes.
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