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. 2023 Jun;38(6):1971-1977.
doi: 10.1007/s00467-022-05840-7. Epub 2022 Dec 16.

Acute kidney injury and early fluid load in a retrospective cohort of neonatal sepsis

Faris N Al Gharaibeh  1   2 , Shruthi Mohan  3 , Michael A Santoro  4 , Cara L Slagle  5   6 , Stuart L Goldstein  6   7
Affiliations

Acute kidney injury and early fluid load in a retrospective cohort of neonatal sepsis

Faris N Al Gharaibeh et al. Pediatr Nephrol. 2023 Jun.

Abstract

Background: Sepsis and acute kidney injury (AKI) are associated with mortality in the newborn intensive care unit (NICU). There is a paucity of studies that describe AKI and fluid overload in neonatal sepsis and their association with mortality.

Methods: Retrospective study of neonates with culture positive sepsis admitted to the NICU between June 2020 and June 2021 was conducted. Primary outcome was in-hospital mortality according to AKI as defined by the neonatal modified Kidney Diseases Improving Outcomes criteria. Secondary outcomes were early fluid overload and vasopressor use.

Results: Thirty-three percent of neonates had AKI with sepsis, and 57% of cases were severe AKI. AKI was associated with mortality after adjusting for variables that were different between survivors and non-survivors (aOR 5.7 [95% CI 1.1-36], p = 0.04). Early fluid overload occurred in 27% of neonates who were at higher risk of having AKI with sepsis (OR 7.4 [95% CI 1.6-26.0], p = 0.01) and higher risk of mortality (aOR 17.8 [95% CI 2-7545], p = 0.02).

Conclusions: AKI and early fluid overload are associated with mortality in sepsis in our retrospective cohort. Mitigating AKI and early fluid overload in sepsis might be a fruitful strategy in reducing mortality with sepsis. A higher resolution version of the Graphical abstract is available as Supplementary information.

Keywords: AKI; Fluid overload; Mortality; Neonatal sepsis.

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