A new approach to recognize term and preterm infants with impaired kidney function (IKF) during the first week of life

crossref(2020)

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摘要
Background Current definitions of neonatal acute kidney injury (nAKI) are not sensitive enough to identify all newborns with impaired kidney function (IKF) during the first week of life. Previous studies in term newborns with hypoxic ischemic encephalopathy showed that the rate of serum creatinine (SCr) decline during the first week of life could be used to assess their renal status. Methods We reviewed the medical records of 329 critically ill newborns ≥ 27 weeks of gestational age (GA), to determine whether the rate of SCr decline combined with SCr thresholds provides a sensitive approach to identify newborns with IKF during the first week of life. Results Excluding neonates with nAKI, identified based on standard definitions, a SCr decline < 31 % by the 7th day of life, combined with a SCr threshold ≥ 0.7 mg/dl, recognized newborns of 40-31 weeks of GA with IKF. A SCr decline < 21% combined with a SCr threshold ≥ 0.8 mg/dl identified newborns of 30-27 weeks of GA with IKF. These neonates (~ 17%) showed a more prolonged hospital stay and required more days of mechanical ventilation, vasoactive drugs, and diuretics, when compared to critically ill controls. Changes in urine output did not distinguish newborns with IKF. Conclusion The rate of SCr decline combined with SCr thresholds identifies newborns with IKF during the first week of life. This distinctive group of newborns that is missed by standard definitions of nAKI, warrants close monitoring in the NICU to prevent acute and chronic renal complications. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study was supported by the National Health Institutes R01 grants # HL102497 and # DK049419 ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes All data available is presented in the manuscript submitted.
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