title: Acute Kidney Injury Following Cardiac Surgery in Neonates and Young Infants: Experience of a Single Center Using Novel Perioperative Strategies.
abstract: OBJECTIVE
  Acute kidney injury (AKI) following cardiac surgery is a serious complication with a reported incidence of 30% to 50%. This study sought to determine the prevalence and risk factors for AKI among neonates and young infants undergoing repair of cardiac defects at an institution using novel perioperative strategies.
  
  
  METHODS
  A retrospective analysis of 102 consecutive infants (<2 months) undergoing repair of cardiac defects on cardiopulmonary bypass formed the study group. Cardiac diagnoses were stratified according to the Society of Thoracic Surgeons Congenital Heart Surgery (STAT) mortality categories. The prevalence of AKI within 72 hours was defined according to the three-stage Acute Kidney Injury Network criteria. Novel bypass strategies to preserve renal function included maintenance of higher hematocrit and high flow rates on cardiopulmonary bypass despite systemic hypothermia, and avoidance of albumin and milrinone in the perioperative period.
  
  
  RESULTS
  Mean age was 24 ± 19 days. Eighteen patients were less than 7 days of age at the time of surgery. Patient distribution according to STAT categories was as follows: 1 (n = 21), 2 (n = 12), 3 (n = 22), 4 (n = 28), and 5 (n = 19). The incidence of stages 1, 2, and 3 AKI in the population was 8% (n = 9), 2% (n = 2), and 0% (n = 0), respectively. On multivariate analysis higher STAT category was the only significant risk factor for AKI.
  
  
  CONCLUSIONS
  Current incidence of AKI following cardiac surgery in young infants at our institution is low. Novel perioperative strategies may have contributed to the low observed incidence of AKI in our patient population. Increased complexity of heart disease was a risk factor for AKI.
authors.affiliation: Department of Pediatric Cardiothoracic Surgery, LeBonheur Children's Hospital and University of Tennessee, Memphis, TN, USA tskumar@uthsc.edu.
authors.forename: T K Susheel
authors.initials: TK
authors.lastname: Kumar
authors.affiliation: Department of Pediatric Cardiothoracic Surgery, LeBonheur Children's Hospital and University of Tennessee, Memphis, TN, USA.
authors.forename: Jerry
authors.initials: J
authors.lastname: Allen Ccp
authors.affiliation: Departments of Pediatrics and Epidemiology, LeBonheur Children's Hospital and University of Tennessee, Memphis, TN, USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Spentzas Md
authors.affiliation: Department of Pediatric Cardiothoracic Surgery, LeBonheur Children's Hospital and University of Tennessee, Memphis, TN, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Berrios Ccp
authors.affiliation: Department of Pediatric Cardiology. LeBonheur Children's Hospital and University of Tennessee, Memphis, TN, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Shah Md
authors.affiliation: Department of Pediatric Cardiology. LeBonheur Children's Hospital and University of Tennessee, Memphis, TN, USA.
authors.forename: Vijaya M
authors.initials: VM
authors.lastname: Joshi Md
authors.affiliation: Department of Pediatric Cardiology. LeBonheur Children's Hospital and University of Tennessee, Memphis, TN, USA.
authors.forename: Jean A
authors.initials: JA
authors.lastname: Ballweg Md
authors.affiliation: Department of Pediatric Cardiothoracic Surgery, LeBonheur Children's Hospital and University of Tennessee, Memphis, TN, USA tskumar@uthsc.edu.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Knott-Craig Md
mesh_terms: D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology*; D000704:Analysis of Variance; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002315:Cardiopulmonary Bypass / Q000009:adverse effects; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: cardiopulmonary bypass; neonate; perioperative care; renal failure