Acute kidney injury in newborns treated in intensive care units: results of a multicenter study
AbstractAccording to the current literature, every third patient of the neonatal intensive care unit (NICU) has a decrease in renal function, with a general heterogeneity of this group.
The frequency of acute kidney injury (AKI) may differ significantly in the study of individual groups of newborns (sepsis, asphyxia, cardiac surgery, premature infants, etc.).
The aim of this study was to compare the frequency of AKI in newborns treated in NICU of various profiles, as well as to establish the distinctive features of risk factors for AKI development.
The study involved structural divisions of maternity clinics, perinatal centers and children's hospitals, taking into account the routing of newborns in the Russian Federation.
Material and methods. The prospective cohort study included 851 newborns from 20 NICUs, of which: the NICU of maternity clinics - 47.9%, the NICU of large perinatal centers - 7.9%, the ICU for newborns and premature infants - 13.6%, the NICU for newborns with surgical pathology - 28.9%, the Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthcare of the Russian Federation -1.6%. The study included all newborns treated in the NICU (from 0 to 28 days of life) and having at least 2 biochemical blood tests to determine the level of serum creatinine with intervals between tests of 48-168 hours. Assessment of the severity of AKI was carried out on a scale kidney disease improving global outcomes (2017).
Results. According to our data, the frequency of neonatal AKI among NICU patients is 22.7%. At the same time, the frequency of AKI development relative to different NICU profiles was comparable. According to our data, the manifestation of AKI episodes in most cases (80.3%) was recorded in the first week of postnatal life. Among the risk factors for AKI, prematurity and surgery had a significant impact. We noted the relationship between the specifics of the NICU and the risk factors of AKI. Thus, among the NICUs of maternity hospitals, the Apgar score was a statistically significant risk factor for AKI, while in the NICU of children's hospitals, there was a correlation between episodes of AKI and pathological weight gain.
Conclusion. The AKI in newborns receiving treatment in the NICU Largely depends on the underlying disease, and, accordingly, the profile of the department. The most important in relation to the development of AKI is the first week of life. Special attention should be paid to the excretory function of the kidneys in premature newborns, surgical patients, and children who have suffered asphyxia in childbirth. By itself, the development of an AKI episode had a significant impact on the average duration of hospitalization, including in the NICU.
Keywords:acute kidney injury, risk factors, morbidity, mortality, neonates, intensive care, renal replacement therapy, preterm infants
Funding. The study had no sponsor support.
Conflict of interests. The authors declare no conflict of interests.
Contributions. General management and organization of research, data collection, data analysis, article writing, preparation of materials for publication - Makulova A.I.; statistical processing, data analysis, writing an article, preparing materials for publication -Zolotareva L.S.; data collection, article writing, preparation of materials for publication - Aborin S.V.; data collection - Golo-midov A.V., Lipp K.N., Vaseeva E.V., Vykhrestyuk A.V., Odenbakh L.A., Delaryu N.V., Zayachnikova T.E., Tolokonnikova E.V., Petrov D.V., Bishyus K.A., Zvereva A.A., Sushkevich E.S., Mazur Yj.E., Borovskaya A.V., Antsiferova E.V., Astakhov R.E., Paunova S.S., Mikheeva A.A., Korsunskiy A.A., Katkov I.V., Sviridova N.V., Spiridonova N.V., Podurovskaya Yu.L., Burov A.A., Zilbert E.V., Tsvetkov I.O., Svetlich-naya T.O., Ermoshina O.G., Nerodik U.V., Biryukova E.V., Gaynetdinov T.M., Kozlova E.M., Kulagin S.Yu., Mal'tseva E.V., Zonov E.A., Bratchikov D.Yu., Bessonova O.V., Kozlova Yu.S., Krasnikova Ts.V., Kuznetsova I.V., Bodrennikov S.M., Vysotskiy V.V., Lukashev K.V., Zorina E.B., Sarzhan A.S., Kharlamova N.V., Shilova N.A., Filippov S.E., Lavrenyuk I.I., Krasil'nikova A.S., Degtyarev D.N.
For citation: Makulova A.I., Zolotareva L.S., Aborin S.V., Golomidov A.V., Lipp K.N., Vaseeva E.V., Vykhrestyuk A.V., Odenbakh L.A., Delaryu N.V., Zayachnikova T.E., Tolokonnikova E.V., Petrov D.V., Bishyus K.A., Zvereva A.A., Sushkevich E.S., Mazur Yu.E., Borovskaya A.V., Antsiferova E.V., Astakhov R.E., Paunova S.S., Mikheeva A.A., Korsunskiy A.A., Katkov I.V., Sviridova N.V., Spiridonova N.V., Podurovskaya Yu.L., Burov A.A., Zilbert E.V., Tsvetkov I.O., Svetlichnaya T.O., Ermoshina O.G., Nerodik U.V., Biryukova E.V., Gaynetdinov T.M., Kozlova E.M., Kulagin S.Yu., Mal'tseva E.V., Zonov E.A., Bratchikov D.Yu., Bessonova O.V., Kozlova Yu.S., Krasnikova Ts.V., Kuznetsova I.V., Bodrennikov S.M., Vysotskiy V.V., Lukashev K.V., Zorina E.B., Sarzhan A.S., Kharlamova N.V., Shilova N.A., Filippov S.E., Lavrenyuk I.I., Krasil'nikova A.S., Degtyarev D.N. Acute kidney injury in newborns treated in intensive care units: results of a multicenter study. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2021; 9 (1): 8-23. DOI: https://doi.org/10.33029/2308-2402-2021-9-1-8-23 (in Russian)
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