Kidney Week

Abstract: TH-OR017

AKI During Late-Onset Sepsis in Neonates: Incidence, Clinical Determinants, and Association with Mortality

Session Information

• AKI Across the Care Continuum: From Detection to Recovery
  October 22, 2026 | Location: Room 203, Convention Center
  Abstract Time: 05:40 PM - 05:50 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Lim, Mary Kirstyleigh Ann Revilla, Westchester Medical Center, Valhalla, New York, United States

Mary Kirstyleigh Ann Revilla Lim, MD

• Hartl, Christine, Westchester Medical Center, Valhalla, New York, United States

Christine Hartl, DO

• Pleta, Patricia, Westchester Medical Center, Valhalla, New York, United States

Patricia Pleta, DO

• Cocuzzo, Brianna L., The University of Texas Southwestern Medical Center Department of Pediatrics, Dallas, Texas, United States

Brianna L. Cocuzzo, MD, MSc

• Lewis, Jessica H., Nuvance Health, Danbury, Connecticut, United States

Jessica H. Lewis, PharmD

• Labrecque, Sophie, Westchester Medical Center, Valhalla, New York, United States

Sophie Labrecque, RN

• Banerjee, Nilanjana, Westchester Medical Center, Valhalla, New York, United States

Nilanjana Banerjee, PhD

• Hodson, Gabrielle Nicole, Westchester Medical Center, Valhalla, New York, United States

Gabrielle Nicole Hodson, PharmD

• Vasovic, Ljiljana V., Westchester Medical Center, Valhalla, New York, United States

Ljiljana V. Vasovic, MD

• Nolan, Sheila M., Westchester Medical Center, Valhalla, New York, United States

Sheila M. Nolan, MD

• Parvez, Boriana, Westchester Medical Center, Valhalla, New York, United States

Boriana Parvez, MD

• Mazo, Alexandra, Loma Linda University, Loma Linda, California, United States

Alexandra Mazo, MD, PhD

Background

Acute kidney injury (AKI) is associated with increased mortality in critically ill neonates. Late-onset sepsis (LOS) may increase AKI risk due to hemodynamic instability and nephrotoxic exposure, but remains poorly characterized. We evaluated the incidence of AKI during first LOS episodes and factors associated with AKI and mortality.

Methods

We conducted a retrospective cohort study of neonates with a first episode of late-onset sepsis (LOS) admitted to a Level IV NICU from November 2020 to November 2023. AKI was defined using neonatal-modified KDIGO criteria. Multivariable logistic regression evaluated associations between vancomycin exposure and AKI, adjusting for gestational age, blood culture positivity, vasopressor use, invasive mechanical ventilation, and patent ductus arteriosus.

Results

Among 247 neonates with LOS, AKI occurred in 23 (9%). Neonates with AKI had lower gestational age and birth weight and were more likely to require vasopressors and invasive ventilation. Overall and 30-day mortality were higher in the AKI group (39% vs 7% and 30% vs 3%, respectively; both P<0.001). Stage 2–3 AKI occurred in 39% and was associated with higher mortality (44%). In multivariable analysis, vancomycin trough concentrations ≥20 µg/mL were independently associated with AKI (adjusted odds ratio [aOR] 4.9, 95% confidence interval [CI] 1.3–17.6, P=0.01), whereas vancomycin duration >48 hours was not (aOR 0.75, 95% CI 0.25–2.3, P=0.61). AKI was documented in only 17% of AKI cases, and 9% received nephrology consultation.

Conclusion

AKI occurred in nearly 1 in 10 neonates during first LOS episodes and was associated with illness severity and mortality. AKI was frequently under-recognized in the NICU. Supratherapeutic vancomycin levels, but not treatment duration, were independently associated with AKI, identifying a potentially modifiable risk factor. These findings support vigilant kidney monitoring and antimicrobial stewardship in high-risk neonates.