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Acute kidney injury in a single neonatal intensive care unit in Turkey
Fatih Bolat, Serdar Comert, Guher Bolat, Oznur Kucuk, Emrah Can, Ali Bulbul, Hasan Sinan Uslu, Asiye Nuhoglu
Istanbul, Turkey
Author Affiliations: Department of Pediatrics, Division of Neonatology, Faculty of Medicine, Cumhuriyet University, Sivas (Bolat F); Department of Pediatrics, Division of Neonatology, Sisli Children Hospital, Istanbul (Bolat F, Comert S, Can E, Bulbul A, Uslu HS, Nuhoglu A); Goztepe Training and Research Hospital, Istanbul (Bolat G); Department of Pediatrics, Medical Faculty, Yeditepe University, Istanbul, Turkey (Kucuk O).
Corresponding Author: Fatih Bolat, MD, Cumhuriyet Üniversitesi, Tıp Fak¨¹ltesi, Çocuk Sağlığı ve Hastalıkları Yenidoğan Kliniği, Sivas, T¨¹rkiye (Tel: 90-03462581171; Fax: 90-03462581305; Email: fatihbolat74@gmail.com)
doi:10.1007/s12519-012-0371-3
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.
Key words: acute kidney injury; mortality; neonatal intensive care unit; prevalence; risk factors
World J Pediatr 2013;9(4):323-329
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