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Pediatric Nephrology

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01-04-2013 | Original Article

Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate

Authors: David J. Askenazi, Rajesh Koralkar, Hayden E. Hundley, Angela Montesanti, Neha Patil, Namasivayam Ambalavanan

Published in: Pediatric Nephrology | Issue 4/2013

Abstract

Background

Acute kidney injury (AKI) is common and portends mortality in several neonatal cohorts. Fluid overload is independently associated with poor outcomes in children and adults but has not been extensively studied in neonates.

Methods

Between February 2010 and May 2011, we followed 58 neonates who met the following criteria: birth weight >2,000 g, gestational age ≥34 weeks, 5-min Apgar ≤7, and parental consent. Serum creatinine (SCr) was measured daily for first 4 days of life. AKI was defined as a rise in SCr of > 0.3 mg/dl or persistent SCr above 1.5 mg/dl.

Results

AKI was present in 9/58 (15.6 %) neonates and was associated with higher birth weight, being male, lower 5-min Apgar scores, lower cord pH, delivery room intubation, and absence of maternal pre-eclampsia. Percent weight accumulation at day 3 of life was higher in those with AKI [median = 8.2, interquartile range (IQR) = 4.4–21.6)] than without AKI (median = −4 (IQR = −6.5 to 0.0) (p < 0.001). Infants with AKI had lower survival rates than those without AKI [7/9 (72 %) vs. 49/49 (100 %) (p < 0.02)].

Conclusions

AKI incidence in this neonatal population is similar to other neonatal cohorts. Near-term/term infants with AKI have a higher mortality rate and a net positive fluid balance over the first few days of life.

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Title: Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate
Authors: David J. Askenazi
Rajesh Koralkar
Hayden E. Hundley
Angela Montesanti
Neha Patil
Namasivayam Ambalavanan
Publication date: 01-04-2013
Publisher: Springer-Verlag
Published in: Pediatric Nephrology / Issue 4/2013
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI: https://doi.org/10.1007/s00467-012-2369-4

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Fluid overload and mortality are associated with acute kidney injury in sick near-term/term neonate

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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