(690) Evaluation of Risk Factors Associated With Acute Kidney Injury in a Level IV Regional NICU

Introduction: Neonatal AKI increases morbidity and mortality. Pediatric hospitals have implemented renal surveillance programs to assess patients at high risk of developing AKI. Previous literature has found variability in clinical, demographic, and medication related risk factors associated with neonatal AKI. The primary objective of this study was to evaluate risk factors associated with development of AKI in the neonatal intensive care unit (NICU).

Methods: Single-center, case-control study at a level IV regional NICU between June 2018-June 2022. Patients with corrected gestational age (GA) less than 45 weeks were included. Cases were those who developed AKI after day 4 of life; defined as a rise in serum creatinine greater than 0.3 mg/dL within 48 hours or greater than 1.5 to 1.9 times baseline at any time or urine output less than 1 mL/kg/hr for 24 hours. Controls were the next neonate admitted to the same NICU team without AKI. Exclusions were need for dialysis, or congenital kidney or heart disease. Maternal and neonatal factors, nephrotoxic medications, and procedures were analyzed. Univariate and multivariate analyses were performed to assess the primary outcome.

Results: A total of 94 patients were included. Univariate analysis revealed the following odds ratios (OR): GA less than 27 weeks, 41 (95% CI 12.3–135.9); birth weight less than 1500 g, 22.9 (95% CI 6.9-75.7); low Apgar score (less than 4 at 1 and 5 minutes of life), 3.4 (95% CI 1.5-8); intubation at birth, 30 (95% CI 6.6-140.2); bronchopulmonary dysplasia, 10.8 (95% CI 4.1-28.1); patent ductus arteriosus (PDA), 20.8 (95% CI 6.3-68.4); necrotizing enterocolitis 9.4 (95% CI 1.1-78.8); and sepsis, 9.4 (95% CI 1.1-78.8). There was no increase in odds of AKI with use of nephrotoxic medications. Odds of AKI increased 13.1-fold in patients with more than 4 risk factors. After controlling for confounding variables, multivariate analysis revealed an OR of 7.7, 4.3, 6.9, and 4.4 for GA less than 27 weeks, intubation at birth, PDA, and vasopressor administration, respectively.

Conclusions: Variables identified to be most associated with AKI include low gestational age, intubation at birth, PDA, and vasopressor use. These factors should be evaluated further for use in renal surveillance systems.