Multidisciplinary neonatal acute kidney injury provider perceptions and practice patterns

A 2017 international survey of neonatologist and pediatric nephrologist (PN) perceptions and practice showed that neonatal acute kidney injury (AKI) was underappreciated, and diagnosis and management varied significantly across centers. An updated survey was developed to determine whether perceptions and practices among international pediatric subspecialists have changed with increased awareness of AKI.

A 50-question electronic survey of AKI detection, monitoring, and follow-up was distributed to neonatologists, PNs, pediatric intensivists, and advanced practice providers (APPs) via 11 professional organizations (mid-March to mid-May 2024). Responses were compared by subspecialty and economic classification of respondents' countries.

Respondents totaled 676 (44.4% neonatologists, 38.3% PNs, 12.0% APPs, < 1.0% pediatric intensivists) representing 68 countries (36.7% high-income, 32.3% upper-middle income, 23.5% lower-middle income, 5.9% low-income, and 1.5% with unclassified economy). The modified, neonatal KDIGO criteria were most frequently used overall (46.1%) to diagnose AKI; however, only 30.7% of neonatologists and 14.8% of APPs utilized KDIGO. Most respondents reported no AKI identification (75.8%) nor monitoring protocol (75%). However, we identified higher rates of reported creatinine surveillance around aminoglycoside (72.9%) and indomethacin use (61.9%) than previously reported (34-36% and 24-62%, respectively) and improved creatinine access via a routine electrolyte panel (> 80% vs. 25-40% in the original survey). PN's availability increased from 75% to > 80%.

Neonatal AKI perceptions and practices continue to vary across subspecialities, though improvements in access to serum creatinine monitoring and nephrology consultation are noted. Standardized approaches for AKI detection, management, and follow-up remain lacking indicating opportunities to improve care through provider education and guideline development.