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Kidney Week

Abstract: FR-PO1076

Improving Recognition and Reporting of AKI in the Neonatal Intensive Care Unit

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Starr, Michelle C., Indiana University School of Medicine, Indinapolis, Indiana, United States
  • Kula, Alexander J., Seattle Children's Hospital, Seattle, Washington, United States
  • Lieberman, Joshua, University of Washington Medical Center, Seattle, Washington, United States
  • Lam, Teresa, University of Washington, Seattle, Washington, United States
  • Chabra, Shilpi, University of Washington, Seattle, Washington, United States
  • Hingorani, Sangeeta R., Seattle Children's Hospital, Seattle, Washington, United States
Background

Neonatal AKI leads to increased short and long-term morbidity and mortality. Recognition of AKI is essential as monitoring can lead to earlier detection of kidney dysfunction, particularly in neonates who are at high risk of CKD. This study determined prevalence of AKI among infants admitted to a NICU, and evaluated the frequency of AKI recognition/reporting over time.

Methods

Records of all infants admitted to a level 3 neonatal intensive care unit from 2012 to 2017 were reviewed. During this time period, several interventions were instituted including AKI education, a dedicated AKI followup clinic, and NICU nephrology rounds. AKI was classified using the Kidney Disease: Improving Global Outcomes definition modified to include only serum creatinine. Continuous variables were compared using t-test, and categorical variables with chi-square or Fisher exact test.

Results

AKI occurred in 19.1% of 1168 infants. AKI varied by gestational age, occurring in 171 (54.3%) of 315 of patients born at 22 weeks to <29 weeks, 36 (5.6%) of 643 patients born from 29 weeks to <36 weeks, and 16 (7.6%) of 210 patients born at 36 weeks or older (Figure 1). Infants with AKI were more likely to die than those without AKI (p<0.001). While AKI was recorded in the discharge summary for only 17.0% of AKI survivors, recognition improved during this study (p=0.03). No infants were referred to a nephrologist for AKI follow-up.

Conclusion

AKI occurred in 1 in 5 NICU patients and in over half of the most premature infants. While AKI was rarely noted in the discharge summary, recognition improved during this study. This may be in part due to dedicated AKI follow-up clinics, AKI specific education, and multidisciplinary rounding which began during this study. Nephrology AKI followup did not occur, highlighting areas for ongoing improvement.

AKI occurance by gestational age among infants; 77% of infants who experenced AKI were born at <29 weeks gestationa age; whereas 85% of infants who did not experience AKI were born at ≥29 weeks

Funding

  • NIDDK Support