Medical Student The University of Toledo College of Medicine and Life Sciences Dublin, Ohio, United States
Background: In the past decade, multiple studies have shown the link between cardiac surgeries in neonates and the development of acute kidney injury (AKI). However, the incidence of AKI in neonates undergoing non-cardiac surgeries is not determined. Objective: Our study aims to evaluate the incidence of peri-operative AKI in neonates undergoing non-cardiac surgeries in the first 28 days of life at our institution. Design/Methods: This study is a retrospective review of neonates admitted to the neonatal intensive care unit at a single center from Nov 14-Jan 22. Neonates aged 0-28 days who required a non-cardiac surgery in the first 28 days of life were included for analysis. Neonates requiring a cardiac surgery, ECMO, a lethal chromosomal abnormality, or those with significant underlying renal disease were excluded from analysis. Data were evaluated for the development of AKI in the 72 hours following surgery according to revised neonatal Kidney Disease: Improving Global Outcomes (KDIGO) criteria for serum creatinine and urine output. We also reviewed the relationship between peri-op fluid balance and mortality. Descriptive statistics were used to summarize patient characteristics. Statistical significance was assessed at an alpha level of 0.05. Results: A total of 764 neonates were included for final analysis. Following surgery, 715 (94%) of neonates did not develop AKI, while 49 (6%) did. Variables associated with a significant increase in severity of AKI included lower gestational age and 5-min APGAR score, discharge disposition, and greater length of stay. A more positive fluid balance in the peri-operative period was associated with AKI severity as well. Compared to major surgeries, the odds of post-surgery AKI were lower for minor surgeries and procedures, though the variability in these odds ratios was quite high due to the small number of subjects who experienced AKI in minor and procedure classes.
Conclusion(s): Neonates requiring surgical intervention in the first 28 days of life may be at increased risk of AKI but have not been well-studied. In this single-center, retrospective analysis, we seek to evaluate the incidence of AKI within 72 hours of non-cardiac surgery and determine associations between AKI and other variables. Significant factors associated with AKI included gestational age, APGAR, fluid balance, and condition of discharge.
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