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Multicenter Study
. 2021 Dec;36(12):3981-3991.
doi: 10.1007/s00467-021-05132-6. Epub 2021 May 21.

Diuretic therapy and acute kidney injury in preterm neonates and infants

Tahagod H Mohamed  1   2   3 , Brett Klamer  4   5   6 , John D Mahan  4   7   8 , John D Spencer  4   7   8   5 , Jonathan L Slaughter  8   9   10
Affiliations
Multicenter Study

Diuretic therapy and acute kidney injury in preterm neonates and infants

Tahagod H Mohamed et al. Pediatr Nephrol. 2021 Dec.

Abstract

Background: Acute kidney injury (AKI) in preterm infants is associated with prolonged hospitalization and high mortality. Diuretic therapy has been used to enhance urine output in preterm infants with AKI. Treatment with diuretics, prescription patterns, and relationship with length of stay (LOS), mechanical ventilation (MV), and mortality in preterm infants who also had AKI have not been fully evaluated.

Methods: This multicenter retrospective study used the Pediatric Hospital Information System database. We included 2121 preterm infants with AKI diagnosis from 46 hospital Neonatal Intensive Care Units (NICUs) born <37 weeks gestational age (GA). Treatment with diuretics, practice patterns across 46 NICUs in the USA, and associated outcomes including LOS, MV, and mortality were evaluated.

Results: Seventy-six percent of infants received at least one dose of diuretics (median treatment 18 days). Diuretic prescription varied significantly across hospitals and ranged from 42 to 96%. Diuretics were used more frequently in infants with younger GA and smaller birth weight. Infants with older GA who received diuretics at or before 28 days postnatally had worse survival even after adjusting for known confounders.

Conclusions: Preterm infants with AKI diagnosis were frequently treated with diuretics. Moreover, infants with younger GA and smaller birth weight were more likely to receive diuretics. Worse survival in infants with older GA who received diuretics could be the result of more underlying severe illness in these infants and not the cause of more severe illness. Prospective studies are needed to best determine patient safety and outcomes with diuretic treatment in preterm infants with AKI. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: Acute kidney injury; Diuretics; Pediatrics; Preterm neonates.

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References

    1. Bellomo R, Kellum JA, Ronco C (2012) Acute kidney injury. Lancet 380:756–766 - DOI
    1. Jetton JG, Boohaker LJ, Sethi SK, Wazir S, Rohatgi S, Soranno DE et al (2017) Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study. Lancet Child Adolesc Health 1:184–194 - DOI
    1. Selewski DT, Charlton JR, Jetton JG, Guillet R, Mhanna MJ, Askenazi DJ et al (2015) Neonatal acute kidney injury. Pediatrics 136:e463–e473 - DOI
    1. Arikan AA, Zappitelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL (2012) Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med 13:253–258 - DOI
    1. Harer MW, Pope CF, Conaway MR, Charlton JR (2017) Follow-up of Acute kidney injury in Neonates during Childhood Years (FANCY): a prospective cohort study. Pediatr Nephrol 32:1067–1076 - DOI

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