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Abstract: TH-OR05

Urine NGAL for AKI Screening Following Triggering of Baby NINJA (Nephrotoxic Injury Negated by Just-in-Time Action)

Session Information

Category: Pediatric Nephrology

  • 1800 Pediatric Nephrology

Authors

  • Slagle, Cara L., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Hemmelgarn, Trina S., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Gavigan, Hailey Woollen, Levine Children's Hospital, Charlotte, North Carolina, United States
  • Krallman, Kelli A., Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
  • Goldstein, Stuart, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
Background

Nephrotoxic medication (NTM) exposure is a cause of neonatal Acute Kidney Injury (AKI). Baby NINJA (Nephrotoxic Injury Negated by Just-in-time Action) is a screening process aimed to reduce NTM exposure and AKI in the neonatal intensive care unit, but requires daily serum creatinine (sCr) screening. Urine neutrophil gelatinase-associated lipocalin (uNGAL) has been associated with AKI and offers a less invasive screening mechanism.

Methods

This single center study observed use of an alternative pathway for daily screening following patient triggering of Baby NINJA starting June 2021. Following triggering, providers were prompted daily for selection of sCr or uNGAL monitoring. If uNGAL was >150 ng/mL, screening was transitioned to daily sCr only. Screening compliance was tracked for quality metrics and calculated by daily sCr or uNGAL obtained divided by NTM exposure days plus 2 days. Process control methods determined trends from baseline. Statistical analysis included Mann-Whitney U Test.

Results

Daily screening compliance increased following implementation of the alternative pathway (pre 78% vs. post 84%, p= 0.006)(Figure 1). 37% of screening occurred by uNGAL with conversion to daily sCr in 21%(21/99) of new exposures. Rates of high NTM exposure per 1000 patient days decreased (8% to 5%, p=0.0002). AKI rates did not differ between pre and post implementation eras. Median uNGAL that triggered conversion was 263 ng/mL (IQR 195-825 ng/mL). Median birth gestational age of those that converted was 30 wks (IQR 25-35 wks). Following implementation, 7 subjects experienced a total of 16 days of AKI. 5 patients had AKI at the time of baby NINJA trigger and continued with daily SCr, while 2 patients uNGALs triggered conversion (859 & 2835 ng/mL). Of the 7 patients with AKI, 4 experienced death within 48 hours of trigger. Clinical uNGAL was obtained with sCr in subjects with AKI with a median uNGAL of 946 ng/mL (IQR 594–2724 ng/mL).

Conclusion

Urine NGAL offers a less invasive screening pathway for AKI from nephrotoxic medication exposure.