Dr THOMAS FORBES1,2,3, PETER SUMMERS1,2,3,4, ALICE VOSKOBOYNIK1,2,3,4, SIMON CARTER1,2,3, RUTH ARMSTRONG5, EMILY SEE2,6,7
1Kidney Regeneration, Murdoch Children’s Research Hospital, Melbourne, Australia, 2Department of Nephrology, Royal Children’s Hospital, Melbourne, Australia, 3Department of Paediatrics, University of Melbourne, Melbourne, Australia, 4Centre for Health Analytics, Melbourne, Australia, 5Neonatal Intensive Care Unit, The Royal Children’s Hospital, Melbourne, Australia, 6Intensive Care Unit, Royal Melbourne Hospital, Melbourne, Australia, 7School of Medicine, University of Melbourne, Melbourne, Australia
Biography:
Bio to come
Aim:
To describe the epidemiology and outcomes of neonatal acute kidney injury (AKI) in a quaternary referral, surgical neonatal intensive care unit (NICU).
Background:
AKI occurs in 30% of neonates in tertiary NICUs and is independently associated with increased mortality, length of NICU stay and chronic kidney disease in adult life.
Methods:
We extracted retrospective electronic medical record (EpicTM) data for all neonates (≤28 days old) admitted to the Royal Children’s Hospital NICU, Melbourne over 6.5 years. AKI was defined by neonatal Kidney Disease Improving Global Outcomes serum creatinine criteria. The primary outcome was 30-day mortality. Secondary outcomes included major adverse kidney events at 30 days (MAKE30), length of NICU stay, AKI documentation, nephrology inpatient consultation and follow-up.
Results:
The median gestational age of the cohort (n=2024) was 37+6 weeks. The mean birth weight was 2.84kg. AKI occurred in 10.2% (n=206) of infants. Persistent stage 1 AKI was most common, followed by transient stage 1 AKI. AKI was associated with an increased risk of 30-day mortality (aOR 4.2; 95%CI 2.4-7.2). Infants with AKI were more likely to develop a MAKE30 (aOR 11.6; 95%CI 7.1-18.9). Adjusted, death-censored, median length of stay was 8.9 days longer in the AKI cohort (95%CI 7.1-10.9; p<0.0001). Associations with AKI following multivariable analysis included gestational age, surgery, vasopressors, patent ductus arteriosus and congenital kidney disease (p<0.001).
Conclusions:
Neonatal AKI is less frequent in our quaternary NICU compared to previous literature, potentially due to the higher gestational age and birth weight in the quaternary referral cohort. This automated, EMR-data-driven approach could be adapted to monitor AKI rates in real time and to assess implementation of AKI quality improvement projects.
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