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Pediatric Nephrology
Published in: Pediatric Nephrology 7/2018

01-07-2018 | Original Article

Acute kidney injury is associated with subsequent infection in neonates after the Norwood procedure: a retrospective chart review

Authors: Megan SooHoo, Benjamin Griffin, Anna Jovanovich, Danielle E. Soranno, Emily Mack, Sonali S. Patel, Sarah Faubel, Katja M. Gist

Published in: Pediatric Nephrology | Issue 7/2018

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Abstract

Background

Acute kidney injury (AKI) and infection are common complications after pediatric cardiac surgery. No pediatric study has evaluated for an association between postoperative AKI and infection. The objective of this study was to determine if AKI in neonates after cardiopulmonary bypass was associated with the development of a postoperative infection.

Methods

We performed a single center retrospective chart review from January 2009 to December 2015 of neonates (age ≤ 30 days) undergoing the Norwood procedure. AKI was defined by the modified neonatal Kidney Disease Improving Global outcomes serum creatinine criteria using (1) measured serum creatinine and (2) creatinine corrected for fluid balance on postoperative days 1–4. Infection, (culture positive or presumed), must have occurred after a diagnosis of AKI and within 60 days of surgery.

Results

Ninety-five patients were included, of which postoperative infection occurred in 42 (44%). AKI occurred in 38 (40%) and 42 (44%) patients by measured serum creatinine and fluid overload corrected creatinine, respectively, and was most commonly diagnosed on postoperative day 2. The median time to infection from the time of surgery and AKI was 7 days (IQR 5–14 days) and 6 days (IQR 3–13 days), respectively. After adjusting for confounders, the odds of a postoperative infection were 3.64 times greater in patients with fluid corrected AKI (95% CI, 1.36–9.75; p = 0.01).

Conclusions

Fluid corrected AKI was independently associated with the development of a postoperative infection. These findings support the notion that AKI is an immunosuppressed state that increases the risk of infection.
Appendix
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Metadata
Title
Acute kidney injury is associated with subsequent infection in neonates after the Norwood procedure: a retrospective chart review
Authors
Megan SooHoo
Benjamin Griffin
Anna Jovanovich
Danielle E. Soranno
Emily Mack
Sonali S. Patel
Sarah Faubel
Katja M. Gist
Publication date
01-07-2018
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 7/2018
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-018-3907-5

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