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. 2024 Sep 3;7(9):e2435043.
doi: 10.1001/jamanetworkopen.2024.35043.

Kidney Health Monitoring in Neonatal Intensive Care Unit Graduates: A Modified Delphi Consensus Statement

Michelle C Starr  1   2 , Matthew W Harer  3 , Heidi J Steflik  4 , Stephen Gorga  5 , Namasivayam Ambalavanan  6 , Tara M Beck  7   8 , Paulomi M Chaudhry  9 , Jennifer L Chmielewski  9 , Marissa J Defreitas  10 , Dana Y Fuhrman  7   11 , Mina Hanna  12 , Catherine Joseph  13 , David M Kwiatkowski  14 , Catherine D Krawczeski  15 , Brianna M Liberio  9 , Shina Menon  16 , Tahagod H Mohamed  17 , Jennifer A Rumpel  18 , Keia R Sanderson  19 , Meredith P Schuh  20 , Jeffrey L Segar  21 , Cara L Slagle  9 , Danielle E Soranno  1 , Kim T Vuong  13 , Jennifer R Charlton  22 , Katja M Gist  23 , David J Askenazi  24 , David T Selewski  25 ; Neonatal Kidney Health Consensus Workshop
Collaborators, Affiliations

Kidney Health Monitoring in Neonatal Intensive Care Unit Graduates: A Modified Delphi Consensus Statement

Michelle C Starr et al. JAMA Netw Open. .

Abstract

Importance: Kidney disease is common in infants admitted to the neonatal intensive care unit (NICU). Despite the risk of chronic kidney disease (CKD) in infants discharged from the NICU, neither evidence- nor expert-based recommendations exist to guide clinical care after discharge.

Objective: To develop recommendations for risk stratification and kidney health monitoring among infants after discharge from the NICU.

Evidence review: At the National Institute of Health-supported Consensus Workshop to Address Kidney Health in Neonatal Intensive Care Unit Graduates meeting conducted in February 2024, a panel of 51 neonatal nephrology experts focused on 3 at-risk groups: (1) preterm infants, (2) critically ill infants with acute kidney injury (AKI), and (3) infants with critical cardiac disease. Using established modified Delphi processes, workgroups derived consensus recommendations.

Findings: In this modified Delphi consensus statement, the panel developed 10 consensus recommendations, identified gaps in knowledge, and prioritized areas of future research. Principal suggestions include risk stratification at time of hospital discharge, family and clinician education and counseling for subsequent kidney health follow-up, and blood pressure assessment as part of outpatient care.

Conclusions and relevance: Preterm infants, critically ill infants with AKI, and infants with critical cardiac disease are at increased risk of CKD. We recommend (1) risk assessment at the time of discharge, (2) clinician and family education, and (3) kidney health assessments based on the degree of risk. Future work should focus on improved risk stratification, identification of early kidney dysfunction, and development of interventions to improve long-term kidney health.

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Conflict of interest statement

Conflict of Interest: All authors report no real or perceived conflicts of interest that could affect the study design, collection, analysis, and interpretation of data, the writing of the report, or the decision to submit the manuscript for publication. For full disclosure, we provide the additional list of authors’ other funding not directly related to this study.

Figures

Figure 1.
Figure 1.
Consensus recommendations for outpatient kidney health follow-up for infants at risk of kidney disease during childhood.
See this image and copyright information in PMC

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