title: Risk factors for and outcomes of acute kidney injury in neonates undergoing complex cardiac surgery.
abstract: OBJECTIVE
  To characterize the epidemiology of and identify risk factors for neonatal cardiac surgery-associated acute kidney injury (CS-AKI) and determine its impact on clinical outcomes.
  
  
  METHODS
  Using secondary analysis of data from an ongoing multiprovincial prospective cohort study, we studied 264 neonates undergoing complex cardiac repair. CS-AKI was defined based on the Acute Kidney Injury Network (AKIN) definition. We used regression modeling and survival analysis (adjusting for covariates) to evaluate associations.
  
  
  RESULTS
  CS-AKI occurred in 64% of the neonates in our study cohort. Lower age, longer cardiopulmonary bypass time, hypothermic circulatory arrest, type of repair, lower preoperative serum creatinine (SCr) level, lower gestational age, and preoperative ventilation were independent risk factors for developing CS-AKI. Neonates with CS-AKI had longer times to extubation, intensive care discharge, and hospital discharge, after adjusting for covariates. Mortality was significantly increased in neonates with AKIN stage 2 or higher CS-AKI. The neonates with CS-AKI had a lower z-score for height at 2-year follow-up and were seen by more specialists.
  
  
  CONCLUSIONS
  Neonatal CS-AKI is common and independently predicts important clinical outcomes, including mortality. Many risk factors are similar to those in older children, but some are unique to neonates. The observation that lower baseline SCr predicts CS-AKI merits further study. The AKIN definition, based on preoperative SCr value, is a reasonable method for defining CS-AKI in neonates. Many previous studies of CS-AKI have excluded neonates; we suggest that future intervention studies on approaches to reducing CS-AKI incidence and improving outcomes should include neonates.
authors.affiliation: Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada. Catherine.Morgan@albertahealthservices.ca
authors.forename: Catherine J
authors.initials: CJ
authors.lastname: Morgan
authors.forename: Michael
authors.initials: M
authors.lastname: Zappitelli
authors.forename: Charlene M T
authors.initials: CM
authors.lastname: Robertson
authors.forename: Gwen Y
authors.initials: GY
authors.lastname: Alton
authors.forename: Reg S
authors.initials: RS
authors.lastname: Sauve
authors.forename: Ari R
authors.initials: AR
authors.lastname: Joffe
authors.forename: David B
authors.initials: DB
authors.lastname: Ross
authors.forename: Ivan M
authors.initials: IM
authors.lastname: Rebeyka
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology* / Q000209:etiology*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors