Abstract: PUB212
Furosemide Prescription and Response in Neonates with AKI
Session Information
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Russell, Benjamin, Nationwide Children's Hospital, Columbus, Ohio, United States
- Tang, Hancong, Nationwide Children's Hospital, Columbus, Ohio, United States
- Bambach, Sven, Nationwide Children's Hospital, Columbus, Ohio, United States
- Slaughter, Jonathan L., Nationwide Children's Hospital, Columbus, Ohio, United States
- Mohamed, Tahagod, Nationwide Children's Hospital, Columbus, Ohio, United States
Background
Diuretic use occurs in 3 of 4 neonates with acute kidney injury (AKI) despite known associations with increased mortality. Prior studies evaluating diuretic response are primarily in infants following cardiac surgery, limited by patient-level data, and assess absolute rather than relative urine output (UOP) differences accounting for pre-dose UOP. Here, we further provide descriptive analysis of furosemide prescription and urine output response in neonates with AKI.
Methods
This is a single-center, retrospective review at a large level IV NICU from 2017 to June 2024. Pre and post-dose UOP (mL/kg/h) were defined as UOP in the 6 hour before and after a dose of furosemide. Mild AKI corresponds to nm-KDIGO stage 1 AKI, while severe AKI corresponds to nm-KDIGO stage 2 or 3 AKI. Because each infant could recieve multiple doses of furosemide, both patient and dose level characteristics are summarized.
Results
A total of n=126 patients recieving n=883 doses were included in the final analysis. Patients were predominately male (60%), white (61%), BW of at least 2501g (56%), and GA of at least 36 weeks (52%). Most infants recieved less than 5 doses (71%), however over 25% recieved greater than 5 doses. Median pre-dose UOP was 2.41mL/kg/h and increased to 3.65mL/kg/h after a dose. Pre-dose UOP decreased with increasing AKI severity, while post-dose UOP varied by AKI stage and severity. Stage 1 and 2 AKI had similar changes in post-dose UOP across lower, median, and upper quartile measurements while Stage 3 AKI had marked absolute and relative difference. Both Stage 3 and Severe AKI had large variance across post-dose UOP response quartiles.
Conclusion
The finding that 1 in 4 neonates with AKI recieved greater than 5 doses of furosemide throughout admission shows both high prescription patterns and exposure. Reference urine output data across AKI stages and severity provide useful clinical information. Next steps would include associating urine output patterns with AKI progression, need for dialysis, and mortality.
Acknowledgment
The Kidney and Urinary Tract Center at Nationwide Children’s Hospital, Columbus, OH.