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Kidney Week

Abstract: PO2292

Baby NINJA (Nephrotoxic Injury Negated by Just-in-Time Action) Transfusion Rates

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Gavigan, Hailey Woollen, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Slagle, Cara L., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Krallman, Kelli A., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Poindexter, Brenda, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Hooper, David K., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

Acute kidney injury (AKI) is associated with poor outcomes in neonates. Nephrotoxic medication (NTM) exposure is a common cause of AKI. Nephrotoxic Injury Negated by Just-in-time Action (NINJA) identifies patients with high NTM burden and recommends daily creatinine (Cr) screening. In neonates, concern for iatrogenic anemia decreases AKI screening. We monitored transfusion rates in our project modeled off the neonatal NINJA adaptation, Baby NINJA.

Methods

Critically ill neonates with high NTM exposure initially received modified Cr monitoring (only with routine labs) before transitioning to standard daily Cr monitoring. Patients transfused 3 days into & up to 7 days after Baby NINJA exposure periods counted as an associated transfusion. Statistical process control methods were used to detect changes from baseline. Χ2 and Poisson regression analyses were used to compare metrics between SCr monitoring eras.

Results

Figure 1 shows an increase in transfusions 15 weeks before an increase in Cr compliance. A decrease in transfusions was sustained through the standard Cr era where the highest rate of Cr compliance was seen. The rate of NINJA-associated transfusions was unchanged. Table 1 shows that Cr compliance increased during each era, transfusions decreased between modified & standard Cr eras, NINJA-associated transfusions remained stable, and transfusion rate changes were independent of NINJA-associated transfusions.

Conclusion

There was no association between transfusion rates and daily Cr testing with Baby NINJA implementation; therefore, critically ill neonates with high risk NTM exposure can safely be screened for NTM associated AKI.

Table 1
 Baseline EraModified Cr EraStandard Cr Erap-value*p-value**p-value***
Cr compliance (%)43.149.182.60.04<0.01<0.01
All RBC transfusion rate (per 1000 NICU patient days)14.628.824.3<0.01<0.01<0.01
NINJA RBC transfusion rate (per 1000 NICU patient days)2.13.42.90.130.520.36
All RBC - NINJA RBC transfusion rate (per 1000 NICU patient days)12.525.421.3<0.010.04<0.01

*baseline vs modified, **modified vs standard, ***baseline vs standard

U chart depicting transfusion rates