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Abstract: SA-OR45

Nephrotoxic Medications and Associated AKI in Hospitalized Neonates

Session Information

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Mohamed, Tahagod, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Abdi, Hibo, Nationwide Children's Hospital, Columbus, Ohio, United States
  • Magers, Jacqueline K., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Prusakov, Pavel A., Nationwide Children's Hospital, Columbus, Ohio, United States
  • Slaughter, Jonathan L., Nationwide Children's Hospital, Columbus, Ohio, United States
Background

Hospitalized neonates in the NICU are frequently treated with nephrotoxic medications (NM), a risk factor for acute kidney injury (AKI) which is associated with increased neonatal morbidity and mortality. Neonatal treatment with NM and subsequent AKI, especially in periviable neonates could be detrimental to nephrogenesis.

Methods

Multicenter retrospective analysis of hospital discharges (2005-2016) using the national Pediatric Hospital Information System database, including 49 pediatric hospitals across the U.S. Treatment with 37 NM in first 28 postnatal days across demographics and clinical variables, and relationship with AKI were evaluated.

Results

Of 192,229 neonates, 74% were treated with at least one NM, Figure 1. AKI prevalence was significantly higher in the NM group (aRR 3.68 [95% CI: 2.85, 4.75]), Figure 2. The aRRs of treatment were increased in <32-week, and <2000 g infants. NMs were prescribed to 90-95% of ≤ 28-week gestational age (GA) neonates. Most treatments with NM (95-98%) occurred in the first 3 postnatal days. IV aminoglycosides were the most frequent NM prescribed; 28% were treated with ≥ 4 calendar days. Most common diagnoses were infections (25%) and patent ductus arteriosus (20%).

Conclusion

The smallest and most immature preterm neonates are frequently treated with NM. the prevalence of AKI is higher in the NM treated group. The long-term implications of treatment with NM and subsequent AKI on nephrogenesis warrant attention in future studies.