Incidence, risk factors, and outcome of acute kidney injury in hospitalized term newborns

Background: Acute kidney injury (AKI) is a common and devastating medical condition. However, the true incidence of AKI around the world is not known. In newborns patients, AKI importance and dilemmas are even more pronounced, as a newborn's kidneys are more susceptible to hypoperfusion and have low glomerular filtration rate. Objective: The objective is to determine the incidence, risk factors, and outcome of AKI in term newborns. Design: Prospective observational. Study Setting: Neonatology Division, Department of Pediatrics, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh. Methods: A hospital-based prospective study was done on 160 term inborn newborns. Babies were closely examined for the occurrence of AKI based on rising creatinine level or falling urine output. Results: The mean birth weight and the mean gestational of the study population were 2.64 (standard deviation [SD] 0.52) and 38.4 weeks (SD 1.05), respectively. Thirty-five babies developed AKI between 24 and 48 h of life. On applying nRIFLE criteria, 21, 7, and 7 babies fell into Stage 1 (risk), Stage 2 (injury), and Stage 3 (failure), respectively. At discharge, all babies showed normalization of renal function test and follow-up ultrasound at 3 months of age did not show any significant abnormality. The presence of asphyxia, comorbid sepsis, and circulatory collapse were found to have a significant association with AKI. The stage of AKI as per nRIFLE criteria significantly affected the outcome of newborns. Conclusion: AKI is a significant problem seen in newborns admitted to NICU. The most common risk factors identified were perinatal asphyxia, sepsis, and circulatory failure. There is a pressing need to improve antenatal care to decrease the burden of asphyxiated newborn and preventing hospital-acquired infection. This may translate into future wellbeing of the newborns.