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. 2021 Aug;41(8):1901-1909.
doi: 10.1038/s41372-021-01119-1. Epub 2021 Jun 12.

Risk factors for acute kidney injury in neonates with congenital diaphragmatic hernia

Brianna M Liberio  1 , John T Brinton  2 , Katja M Gist  3 , Danielle E Soranno  4 , Megan J Kirkley  5   6 , Jason Gien  5
Affiliations

Risk factors for acute kidney injury in neonates with congenital diaphragmatic hernia

Brianna M Liberio et al. J Perinatol. 2021 Aug.

Abstract

Objective: To examine incidence of acute kidney injury (AKI), antenatal and postnatal predictors, and impact of AKI on outcomes in infants with congenital diaphragmatic hernia (CDH).

Study design: Single center retrospective study of 90 CDH infants from 2009-2017. Baseline characteristics, CDH severity, possible AKI predictors, and clinical outcomes were compared between infants with and without AKI.

Result: In total, 38% of infants developed AKI, 44% stage 1, 29% stage 2, 27% stage 3. Lower antenatal lung volumes and liver herniation were associated with AKI. Extracorporeal life support (ECLS), diuretics, abdominal closure surgery, hypotension, and elevated plasma free hemoglobin were associated with AKI. Overall survival was 79%, 47% with AKI, and 35% with AKI on ECLS. AKI is associated with increased mechanical ventilation duration and length of stay.

Conclusion: AKI is common among CDH infants and associated with adverse outcomes. Standardized care bundles addressing AKI risk factors may reduce AKI incidence and severity.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Incidence and Timing of AKI.
a Stratification by stage of AKI. Total number of patients with AKI is 34, representing 37.8% of the entire cohort. Upon stratification by stage of AKI, there was 44% with stage 1 AKI, 29% stage 2 AKI, and 27% stage 3 AKI. b Distribution of day of AKI onset. The median day of AKI diagnosis was day of life 12 [IQR: 7.5, 19.5]. AKI acute kidney injury.
Fig. 2
Fig. 2. Effects of AKI on Selected Long-term Outcomes.
a Effects of AKI on survival. There was 47% survival for those with AKI and 98% survival for those without AKI (p < 0.0001). Survival rates decreased with increasing stage of AKI. Of those requiring ECLS, survival was 47%, with 35% survival for those with AKI vs. 100% survival for those without AKI. b Effects of AKI on duration of mechanical ventilation and length of hospital stay. Median duration of mechanical ventilation was 13 days [IQR: 8, 18.5] for survivors without AKI and 23.5 days [IQR: 15.5, 33] for survivors with AKI (p < 0.02). Median length of hospital stay was 39 days [IQR: 29.5, 66] for survivors without AKI and 59 days [IQR: 47, 91.75] for survivors with AKI (p < 0.05). AKI acute kidney injury, ECLS extracorporeal life support.
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