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Updated: Jan 17, 2026
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Published on: October 28, 2022
Poor hemodynamic profile is associated with acute kidney injury in very low birth weight infants
Omer Guran1, Funda Yavanoglu Atay1, Ozlem Sahin1
1Department of Neonatology, University of Health Sciences, Umraniye Training and Research Hospital, Umraniye, Istanbul, Turkey.
Insights
Acute kidney injury (AKI) affects 16% of very low birth weight (VLBW) infants. Hypotension and prolonged inotrope use are key risk factors, necessitating early identification and hemodynamic monitoring in high-risk neonates.
Area of Science:
- Neonatology
- Pediatric Nephrology
- Critical Care Medicine
Background:
- Very low birth weight (VLBW) infants surviving acute kidney injury (AKI) may face long-term chronic kidney disease risks.
- Limited large cohort studies exist on AKI risk factors in VLBW infants.
Purpose of the Study:
- To retrospectively identify risk factors for AKI development in VLBW infants.
- To compare clinical characteristics of VLBW infants with and without AKI.
Main Methods:
- Retrospective analysis of VLBW infants (<1500g) admitted to the NICU between 2019-2022.
- Comparison of infants who developed AKI versus those who did not.
Main Results:
- 16% (35/218) of VLBW infants developed AKI.
- Lower gestational age, birth weight, longer mechanical ventilation, inotrope/vancomycin use, PDA, NEC, and IVH were associated with AKI.
- Independent predictors of AKI included lower gestational age and inotrope use ≥3 days.
Conclusions:
- Hypotension is a significant predictor of AKI in VLBW infants.
- Early identification and close hemodynamic monitoring are crucial for preventing AKI in preterm neonates.
Background:
Survivors of acute kidney injury (AKI) in very low birth weight (VLBW) infants may be at risk of developing chronic kidney disease in the long term. Large cohort studies examining risk factors associated with AKI in VLBW infants are scarce.
Methods:
We retrospectively investigated the risk factors for the development of AKI by comparing the file records of VLBW infants (<1500 g) born between 2019 and 2022 and admitted to the neonatal intensive care unit with and without AKI.
Results:
Of the 218 VLBW infants enrolled, 35 (16%) developed AKI. The AKI group had lower gestational age (25.3 vs. 28.9 weeks) and birth weight (760 g vs. 1060 g) compared to the no AKI group (p < 0.001). Longer duration of mechanical ventilation, higher rates of inotrope and vancomycin therapy, patent ductus arteriosus (PDA), grade 2-3 necrotizing enterocolitis (NEC), and severe intraventricular hemorrhage (IVH) were more common in the AKI group (p < 0.001). In multivariate analysis, gestational age (OR 0.70, 95% CI 0.50-0.98, p = 0.036) and inotrope use ≥3 days (OR 6.13, 95% CI 2.06-18.25, p = 0.001) were independently associated with AKI.
Conclusion:
Hypotension is a strong predictor of the development of AKI in VLBW infants in the NICU. Our findings highlight the importance of early identification of high-risk neonates and closer hemodynamic monitoring to prevent AKI in very preterm infants.
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