Acute kidney injury in a single neonatal intensive care unit in Turkey.
BACKGROUND
Although advances in perinatal medicine have increased the survival rates of critically ill neonates, acute kidney injury (AKI) is still one of the major causes of mortality and morbidity in neonatal intensive care units. This study aimed to determine the prevalence of AKI and analyze demographic data and risk factors associated with the mortality or morbidity.


METHODS
Of 1992 neonates hospitalized between January 2009 and January 2011, 168 with AKI were reviewed in the study. The diagnosis of AKI was based on plasma creatinine level >1.5 mg/dL, which persists for more than 24 hours or increases more than 0.3 mg/dL per day after the first 48 hours of birth while showing normal maternal renal function.


RESULTS
The prevalence of AKI was 8.4%. The common cause of AKI was respiratory distress syndrome, followed by sepsis, asphyxia, dehydration, congenital anomalies of the urinary tract, congenital heart disease, and medication. The prevalence of AKI in neonates with birth weight lower than 1500 g was about three-fold higher than in those with birth weight higher than 1500 g (P<0.05). Pregnancy-induced hypertension, preterm prolonged rupture of membranes, and administration of antenatal corticosteroid were associated with increased risk of AKI (P<0.05). Umbilical vein catheterization, mechanical ventilation and ibuprofen therapy for patent ductus arteriosus closure were found to be associated with AKI (P<0.05). The overall mortality rate was 23.8%. Multivariate analysis revealed that birth weight less than 1500 g, mechanical ventilation, bronchopulmonary dysplasia, anuria, and dialysis were the risk factors for the mortality of infants with AKI.


CONCLUSIONS
Prenatal factors and medical devices were significantly associated with AKI. Early detection of risk factors can reduce the mortality of AKI patients.
Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey, fatihbolat74@gmail.com.
Fatih
F
Bolat
Serdar
S
Comert
Guher
G
Bolat
Oznur
O
Kucuk
Emrah
E
Can
Ali
A
Bulbul
Hasan Sinan
HS
Uslu
Asiye
A
Nuhoglu
D058186:Acute Kidney Injury / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality*; D001002:Anuria / Q000150:complications; D001238:Asphyxia Neonatorum / Q000150:complications; D001806:Blood Urea Nitrogen; D001997:Bronchopulmonary Dysplasia / Q000150:complications; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003404:Creatinine / Q000097:blood; D003681:Dehydration / Q000150:complications; D064420:Drug-Related Side Effects and Adverse Reactions / Q000150:complications; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects; D006330:Heart Defects, Congenital / Q000150:complications; D006801:Humans; D007010:Hyponatremia / Q000150:complications; D007022:Hypotension / Q000150:complications / Q000188:drug therapy; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D008297:Male; D015999:Multivariate Analysis; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects; D012121:Respiration, Artificial / Q000009:adverse effects; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000150:complications; D014551:Urinary Tract / Q000002:abnormalities
D002316:Cardiotonic Agents; D005938:Glucocorticoids; D003404:Creatinine