Kidney Week

Abstract: FR-PO106

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

Session Information

• AKI Clinical: Outcomes and Biomarkers
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

• 003 AKI: Clinical and Translational

Authors

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

David T. Selewski,

• 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

Neonates in the neonatal intensive care unit(NICU) are at increased risk of AKI and disorders of fluid balance(FB). Although normal term neonates are expected to lose weight (5-10%) over the first week of life, a paucity of data exists on FB in critically ill neonates. We aim to evaluate FB in the first week of life in a multi-center cohort of critically ill near-term/term neonates and the impact of FB on outcomes.

Methods

The Assessment of Worldwide Acute Kidney injury Epidemiology in Neonates (AWAKEN) study included NICU admissions at 24 institutions (4 countries) 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 anomaly or death at ≤48 hrs. This analysis includes infants ≥36 wks gestational age admitted by DOL 7. FB was defined by percentage change in weight from birthweight(BW). Outcomes: Mechanical ventilation(MV) at DOL 7, NICU mortality

Results

749 neonates were included, median peak FB was 0.6%(-0.8, 4.3) and occurred at a median DOL 2(IQR 1,5). Peak FB over the first week was: <0%(<BW) in 231(30.5%), 0-5% in 345(45.4%), 5-10% in 90(11.9%), 10-15% in 39(5.1%), and >15% in 44(5.9%). 67(9%) were on MV on DOL 7 and 17(2.3%) died. Table 1 describes the association of variables, including FB, with MV at DOL 7. FB was not associated with mortality.

Conclusion

The AWAKEN study describes for the first time, the epidemiology and impact of FB in critically ill near-term/term neonates. Over half of the cohort had a positive peak FB in the first week of life. Peak FB during the first week of life was associated with the need for MV at DOL 7.

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