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ORIGINAL ARTICLE
Year : 2018  |  Volume : 7  |  Issue : 4  |  Page : 237-242

Prevalence and factors affecting prognosis in neonates with acute kidney injury in a neonatal intensive care unit


1 Department of Pediatrics, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
2 Department of Pediatrics, Bhima Bhoi Medical College, Balangir, Odisha, India

Correspondence Address:
Dr. Bijay Kumar Meher
C/455, Sec-6, CDA, Cuttack - 753 014, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcn.JCN_51_18

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Objective: To study the prevalence of acute kidney injury (AKI) in a neonatal intensive care unit (NICU) and to determine the prognostic factors affecting outcomes. Design: This was a prospective, observational study. Setting: The study was conducted at the NICU of a tertiary care hospital. Patients: Seven hundred and two neonates aged between 0 and 28 days were admitted to the NICU between February and November 2017. Of these, 53 had AKI (serum creatinine ≥1.5 mg/dL), and after applying the exclusion criteria, 50 neonates were analyzed. Methods: Frequency distribution was computed using frequency or descriptive statistics procedure. Association of factors was studied by Chi-square test of association and independent sample t-test. Main Outcome Measures: The measures were prevalence of AKI, predisposing factors, complications, need for mechanical ventilation, duration of NICU stay, and mortality. Results: The prevalence of AKI was 7.54%, with a mean age at diagnosis of 4.24 ± 2.58 days. Dehydration was present in 30% of the neonates and nephrotoxic drug use was found in 54%. Birth asphyxia was present in 50%, 78% were septicemic, and 6% had respiratory distress syndrome. The mean serum creatinine level at diagnosis was 2.15 ± 1.23 mg/dL. The mortality rate was 18%. There was no difference in mortality by sex, gestational age, birth weight, presence of sepsis, birth asphyxia, dehydration, hyponatremia, or metabolic acidosis. However, oliguria, high mean serum creatinine levels, and mechanical ventilation were associated with mortality (P < 0.05). Hyperkalemia at diagnosis of AKI was associated with higher mortality, but this was not statistically significant (P = 0.055). Decrease in urea and creatinine levels over 48 h was associated with survival (P < 0.05). Conclusions: The prevalence of AKI in the NICU is high, with poor prognostic factors including oliguria, high mean serum creatinine level, and mechanical ventilation.


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