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Kidney Week

Abstract: PO2282

AKI in Neonatal Congenital Diaphragmatic Hernia

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Liberio, Brianna M., Children's Hospital Colorado, Aurora, Colorado, United States
  • Gist, Katja M., Children's Hospital Colorado, Aurora, Colorado, United States
  • Brinton, John T., University of Colorado, Denver, Colorado, United States
  • Soranno, Danielle, Children's Hospital Colorado, Aurora, Colorado, United States
  • Kirkley, Megan J., University of Colorado, Denver, Colorado, United States
  • Gien, Jason, Children's Hospital Colorado, Aurora, Colorado, United States
Background

Acute kidney injury (AKI) occurs in about 30% of hospitalized neonates and is independently associated with mortality. Infants with congenital diaphragmatic hernia (CDH) are frequently exposed to nephrotoxic medications, fluid shifts, surgery, cardiopulmonary compromise, and extracorporeal life support (ECLS). As such, they are cited to have an increased AKI incidence. We sought to determine prenatal characteristics and postnatal exposures associated with an increased risk of AKI in neonates with CDH during the first 30 days of life, as well as the impact of AKI on selected long-term outcomes.

Methods

We performed a single-center retrospective review of neonates with CDH from 2009 to 2017. AKI was defined by the modified neonatal Kidney Disease Improving Global Outcomes serum creatinine criteria. Differences in prenatal characteristics, patient demographics, and long-term outcomes were assessed between those with and without AKI. We used longitudinal models with and without lagged predictions to determine associations between postnatal exposures and AKI.

Results

90 infants with CDH were included. In the cohort, median gestational age was 38 weeks [IQR: 36, 38], median birthweight was 2.89 kilograms [IQR: 2.5, 3.19], 56% were male, and 50% were outborn. AKI occurred in 34 (37.8%) infants during the first 30 days of life. Specifically, 15 (44%) had stage 1, 10 (29%) had stage 2, 9 (26%) had stage 3, and 8 (24%) received renal replacement therapy. Antenatally, infants with AKI had lower estimates of lung volume (percent predicted lung volume, total lung volume, lung to head ratio, observed to expected lung to head ratio) and higher occurrences of liver up. Postnatally, ECLS, nephrotoxin exposure, CDH repair, abdominal closure, and 10% fluid overload significantly increased the odds of AKI development at varying time-points in the lagged predictions model. Those with AKI had increased mortality and almost two times greater length of stay and duration of mechanical ventilation.

Conclusion

AKI is common among neonates with CDH. In our cohort, greater CDH severity assessed antenatally conferred greater odds of AKI, and those with AKI had worse long-term outcomes. Attention to kidney function should be paid to neonates with fluid overload, on ECLS, exposed to nephrotoxins, or in the post-operative period, given the increased odds of AKI in such situations.