title: Epidemiology of cardiac surgery-associated acute kidney injury in neonates: a retrospective study.
abstract: BACKGROUND
  Cardiac surgery is a known risk factor for acute kidney injury (AKI) in children. However, cardiac surgery-associated AKI (CS-AKI) in neonates has not been well studied. The objectives of this study were: (1) to describe the epidemiology of CS-AKI in neonates utilizing the Acute Kidney Injury Network (AKIN) definition, (2) to identify risk factors for neonatal CS-AKI, and (3) to determine if neonatal CS-AKI is associated with increased morbidity and mortality.
  
  
  METHODS
  This was a retrospective study involving 122 neonates (≤28 days) undergoing cardiac surgery from 2006 to 2009. Neonates with and without AKI were identified using serum creatinine (SCr) and urine output (UO) data.
  
  
  RESULTS
  Cardiac surgery-AKI occurred in 76 (62 %) neonates, of whom 22 (29 %) were AKIN stage 1, 19 (25 %) were stage 2, and 35 (46 %) were stage 3. AKI mostly occurred early as 75 % of patients achieved their maximal AKIN stage within the first 48 h post-operatively. In the multivariate analysis, cardiopulmonary bypass duration of ≥120 min was independently associated with AKI [odds ratio (OR) 2.53, 95 % confidence interval (CI) 1.03-6.30]. Severe AKI (AKIN stage 3) was independently associated with mortality (OR 6.70, 95 % CI 1.08-41.50) and a longer stay in the pediatric intensive care unit (hazard ratio 9.09, 95 % CI 1.35-60.95). The majority of severe AKI cases (65 %) were identified with AKIN UO criteria alone without significant rises in SCr.
  
  
  CONCLUSIONS
  Cardiac surgery-AKI is common in neonates when the AKIN definition is utilized and is associated with higher morbidity and mortality, especially in those with more severe AKI.
authors.affiliation: Division of Nephrology, British Columbia Children's Hospital, 4480 Oak Street, Vancouver, BC, Canada. alabbasae@yahoo.com
authors.forename: Abdullah
authors.initials: A
authors.lastname: Alabbas
authors.forename: Andrew
authors.initials: A
authors.lastname: Campbell
authors.forename: Peter
authors.initials: P
authors.lastname: Skippen
authors.forename: Derek
authors.initials: D
authors.lastname: Human
authors.forename: Douglas
authors.initials: D
authors.lastname: Matsell
authors.forename: Cherry
authors.initials: C
authors.lastname: Mammen
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D000367:Age Factors; D015415:Biomarkers / Q000097:blood; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D016009:Chi-Square Distribution; D003404:Creatinine / Q000097:blood; D006801:Humans; D007223:Infant; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014554:Urination
chemical_list: D015415:Biomarkers; D003404:Creatinine