Kidney Week

Abstract: SA-OR107

The Epidemiology and Impact of Fluid Balance on Outcomes in Critically Ill Preterm Neonates: A Report from the AWAKEN Study

Session Information

• What Happens After AKI
  November 04, 2017 | Location: Room 295, Morial Convention Center
  Abstract Time: 05:42 PM - 05:54 PM

Category: Acute Kidney Injury

• 003 AKI: Clinical and Translational

Authors

• Selewski, David T., University of Michigan, Ann Arbor, Michigan, United States

David T. Selewski, MD, MS

• Akcan Arikan, Ayse, Baylor College of Medicine, Houston, Texas, United States

Ayse Akcan Arikan,

• Bonachea, Elizabeth, Nationwide Children''s hospital, Columbus, Ohio, United States

Elizabeth Bonachea,

• Gist, Katja M., University of Colorado, Children''s Hospital Colorado, Aurora, Colorado, United States

Katja M. Gist,

• Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States

Stuart Goldstein,

• Hanna, Mina, University of Kentucky , Lexington, Kentucky, United States

Mina Hanna,

• Joseph, Catherine, University of New Mexico, Albuquerque, New Mexico, United States

Catherine Joseph,

• Mahan, John D., Nationwide Children's Hospital, Columbus, Ohio, United States

John D. Mahan,

• Nada, Arwa, LeBonheur Children's Hospital, Memphis, Tennessee, United States

Arwa Nada,

• Nathan, Amy, Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio, United States

Amy Nathan,

• Reidy, Kimberly J., Children's Hospital at Montefiore/ Albert Einstein College of Medicine, Bronxville, New York, United States

Kimberly J. Reidy,

• Staples, Amy, University of New Mexico, Albuquerque, New Mexico, United States

Amy Staples,

• Wintermark, Pia, McGill University, Montreal, Quebec, Canada

Pia Wintermark,

• Boohaker, Louis J., Children''s of Alabama, Hoover, Alabama, United States

Louis J. Boohaker,

• Griffin, Russell, University of Alabama at Birmingham, Birmingham, Alabama, United States

Russell Griffin,

• Askenazi, David J., University of Alabama at Birmingham , Birmingham, Alabama, United States

David J. Askenazi,

• Guillet, Ronnie, University of Rochester, Rochester, New York, United States

Ronnie Guillet,

Group or Team Name

• On behalf of Neonatal Kidney Collaborative

Background

Critically ill preterm neonates are at risk of AKI and disorders of fluid balance(FB). Very little data exist on the association between FB and outcomes in this population. We aim to evaluate the epidemiology of FB over the first week of life and impact on outcomes in a multi-center cohort of premature neonates.

Methods

The Assessment of Worldwide Acute Kidney injury Epidemiology in Neonates(AWAKEN) study included neonatal ICU admissions at 24 institutions from 01/14-03/14. Inclusion criteria: intravenous fluids for ≥48 hrs. Exclusion criteria: congenital heart disease repair at <7 days of life (DOL), lethal chromosomal anomaly or death ≤48 hrs. This analysis includes infants <36 weeks gestational age admitted by DOL 7. FB during the first week of life was defined by percent change in weight from birthweight. Outcomes: Mechanical ventilation(MV) at DOL 7, mortality

Results

1136 preterm neonates were enrolled. Median peak FB was 0%(IQR -2.9, 1.9) at median DOL 2 (IQR 1,5). The pattern of peak FB over the first week included: < birthweight in 510(44.8%), 0-5% in 458(40.2%), 5-10% in 83(7.3%), 10-15% in 34(3.0%) and >15% in 51(4.9%). 155(13.6%) were on MV at DOL 7 and 46(4%) died. Table 1 describes the association of variables, including FB, with MV at DOL 7. Peak FB was higher in non-survivors (0%(IQR -2.9,1.7) v 0%(IQR-1.2, 9.3), p=0.002).

Conclusion

The AWAKEN study describes the impact of FB in the first week of life on outcomes in preterm infants. Over half of the cohort had a positive peak FB in the first week of life. Peak FB was associated with MV at DOL 7 and mortality in this cohort.

Table 1: Association of variables with Mechanical Ventilation at day of life 7