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Abstract: PO1951

Improving the Identification of AKI in the Neonatal ICU: Three Centers' Experiences

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Starr, Michelle C., Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Chaudhry, Paulomi, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Brock, Allyson, Indiana University School of Medicine, Indianapolis, Indiana, United States
  • Vincent, Katherine, Medical University of South Carolina, Charleston, South Carolina, United States
  • Twombley, Katherine, Medical University of South Carolina, Charleston, South Carolina, United States
  • Bonachea, Elizabeth, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Mohamed, Tahagod, Nationwide Children's Hospital, Columbus, Ohio, United States
Background

Acute kidney injury (AKI) is common in neonates. Despite its high prevalence, neonatal AKI is diagnosed in <30% of affected neonates. Neonates with AKI are at increased risk for repeated episodes of AKI and CKD. Without an AKI diagnosis, neonates may not be identified for long-term follow up, reducing early identification of CKD and limiting opportunities to slow disease progression.

Methods

In this retrospective cohort study of 3 academic Neonatal Intensive Care Units (NICUs), we evaluated the impact of local standardized approaches implemented to improve neonatal AKI identification. Each center implemented different standardization practices, ranging from automated nephrology consult to neonatology identification based on creatinine. Patients were divided into two groups: 6 months prior to (Cohort 1) and 6 months following (Cohort 2) standardization. We compared AKI incidence and identification, nephrology consultation and nephrology follow-up.

Results

In total, 1887 infants were included. Neonatal AKI identification improved in all three NICUs following protocol implementation (26% to 85%, p<0.0001). Each center also saw increases in nephrology consultation (15% to 83%, p<0.0001) and nephrology follow-up (7% to 73%, p<0.0001). Notably, AKI incidence decreased significantly (21% to 12%, p<0.0001).

Conclusion

Multiple strategies can be successfully operationalized to improve neonatal AKI identification. While different in approach, each strategy resulted in increased AKI identification and nephrology involvement. We also report a decrease in AKI rates. This study emphasizes the importance of local standardized approaches to improve AKI identification in the NICU. Further collaborative work by nephrologists and neonatologists is needed to improve identification and follow-up of AKI.

AKI identification rates between Cohorts 1 and 2