Acute kidney injury in neonatal encephalopathy: an evaluation of the AWAKEN database.
BACKGROUND
Acute kidney injury (AKI) is common in neonatal encephalopathy (NE) and is associated with worse outcomes. Our objectives were to determine the incidence, risk factors, and outcomes of AKI in infants with NE.


METHODS
We performed a retrospective analysis of infants ≥ 34 weeks' gestational age with a diagnosis of NE from the Analysis of Worldwide Acute Kidney injury Epidemiology in Neonates (AWAKEN) database. AKI was defined using the modified Kidney Disease Improving Global Outcomes criteria. Perinatal and postnatal factors were evaluated. Multivariate logistic and linear regressions were performed.


RESULTS
One hundred and thirteen patients with NE were included. 41.6% (47) developed AKI. Being born outside the admitting institution (OR 4.3; 95% CI 1.2-14.8; p = 0.02), intrauterine growth restriction (OR 10.3, 95% CI 1.1-100.5; p = 0.04), and meconium at delivery (OR 2.8, 95% CI 1.04-7.7; p = 0.04) conferred increased odds of AKI. After controlling for confounders, infants with AKI stayed in the hospital an average of 8.5 days longer than infants without AKI (95% CI 0.79-16.2 days; p = 0.03).


CONCLUSIONS
In this multi-national analysis, several important perinatal factors were associated with AKI and infants with both NE and AKI had longer length of stay than NE alone. Future research aimed at early AKI detection, renoprotective management strategies, and understanding the long-term renal consequences is warranted in this high-risk group of patients.
['Kirkley|Megan J|MJ|0000-0001-9349-9960', 'Boohaker|Louis|L|', 'Griffin|Russell|R|', 'Soranno|Danielle E|DE|', 'Gien|Jason|J|', 'Askenazi|David|D|', 'Gist|Katja M|KM|', '|||']
D058186:Acute Kidney Injury D001238:Asphyxia Neonatorum D001927:Brain Diseases D016208:Databases, Factual D066264:Datasets as Topic D005260:Female D005317:Fetal Growth Retardation D005865:Gestational Age D006801:Humans D015994:Incidence D007231:Infant, Newborn D007234:Infant, Premature D007902:Length of Stay D008297:Male D011247:Pregnancy D012189:Retrospective Studies D012307:Risk Factors
Acute kidney injury Neonatal encephalopathy Neonate Hypoxic-ischemic encephalopathy