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Year : 2018  |  Volume : 7  |  Issue : 3  |  Page : 190

Incidence and predictors of acute kidney injury in birth asphyxia

Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Web Publication2-Aug-2018

Correspondence Address:
Dr. Jogender Kumar
1044, Sector 15 B Chandigarh - 160 015
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcn.JCN_116_17

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How to cite this article:
Kumar J. Incidence and predictors of acute kidney injury in birth asphyxia. J Clin Neonatol 2018;7:190

How to cite this URL:
Kumar J. Incidence and predictors of acute kidney injury in birth asphyxia. J Clin Neonatol [serial online] 2018 [cited 2020 Jul 10];7:190. Available from: http://www.jcnonweb.com/text.asp?2018/7/3/190/238390


We read with great interest the article by Aslam et al., published in this journal and found it very useful.[1] However, at the same time would like to offer the following comments, clarification to which would benefit the readers of this journal and will help in replication of these results in different settings.

  1. The author used acute kidney injury (AKI) network criteria for defining and staging AKI stating it as the latest definition. Kidney Diseases: Improving Global Outcomes (KDIGO) published modified definitions in 2013 and endorsed that these definitions should be used in future to define AKI in neonates.[2],[3] There is a fundamental difference in Stage 3 of both the definitions. Hence, the use of KDIGO definition would have been a better choice.
  2. Under introduction, heading authors mentioned that previous study done in asphyxiated neonates used urea and creatinine to define AKI and states that most of the neonates have nonoliguric AKI, so these studies underestimated the prevalence. Despite having multiple limitations of urine output in first 24 h and inherent problems with creatinine, these are still used as gold standard, and all the definitions are based on these criteria only.[4] Even the present study used the same criteria. So citing the use of urine output as a measurement criterion leading to underestimation seems to be unreasonable.
  3. Initial renal function test of neonate may reflect maternal urea and creatinine.[2] Hence, it must be compared between two groups in baseline characteristics.
  4. The present study highlights an important fact that instead of single value done on day 1, serial values are more important. It would have been better if authors present day-wise distribution of AKI. It will help in better understanding of this finding.
  5. In the present study, the outcome was not different among various stages of AKI. However, as per literature, as the AKI stages progress outcome worsens.[2] Why this finding was different from other studies has not been explained?
  6. Instead of mean, the median should be used to compare Apgar score.
  7. The WHO definition for birth asphyxia is mainly meant for community settings, and it gives a very crude estimate. In hospital settings, better definitions (AAP: American Academy of Pediatrics, NNPD: National Neonatal Perinatal Database) should be used for asphyxia to make it comparable to other studies. The difference in findings such as lack of association of stages of AKI with severity may be due to this difference in definitions.
  8. In the current study, more babies have AKI Stage 3 than AKI Stage 1 which is contrary to the literature. This finding may be due to use of diaper weighing for measurement of urine output and hence misclassifying it as AKI Stage 3. Hence, in research settings, where urine output measurement is defining primary outcome using such a crude estimate questions the internal as well as the external validity of the study.

Notice: This letter had been sent to the author of the article but unfortunately, there was no response.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Aslam M, Arya S, Chellani H, Kaur C. Incidence and predictors of acute kidney injury in birth asphyxia in a tertiary care hospital. J Clin Neonatol 2017;6:240.  Back to cited text no. 1
  [Full text]  
Selewski DT, Charlton JR, Jetton JG, Guillet R, Mhanna MJ, Askenazi DJ, et al. Neonatal acute kidney injury. Pediatrics 2015;136:e463-73.  Back to cited text no. 2
Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012;2:1-138.  Back to cited text no. 3
Askenazi DJ, Koralkar R, Patil N, Halloran B, Ambalavanan N, Griffin R, et al. Acute kidney injury urine biomarkers in very low-birth-weight infants. Clin J Am Soc Nephrol 2016;11:1527-35.  Back to cited text no. 4


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