Resident Physician University of Iowa Tiffin, Iowa, United States
Background: Acute kidney injury (AKI) commonly afflicts infants in the neonatal intensive care unit (NICU). Emerging data suggest that AKI promotes inflammation, disruption of the blood brain barrier, and neuronal apoptosis. Existing, qualitative neuroimaging work suggests that premature infants with AKI may develop white matter abnormalities at term-equivalent age compared to premature infants without AKI. However, no quantitative neuroimaging study has evaluated long-term brain outcomes in those with history of premature birth and AKI. Objective: Pilot study to characterize structural brain integrity in children with history of neonatal AKI. Design/Methods: Research participants were enrolled in the Transfusion of Prematurity (TOP) trial during NICU admission. A subset of participants returned for TOP follow-up between ages 5-10 years for brain magnetic resonance imaging (MRI). This works in progress evaluated a retrospective chart review of individual neonates participating in the TOP study at the University of Iowa who completed long-term follow-up including quantitative, research-based MRI scans after at least 5 years of age. Each scan included white matter diffusion sequences to quantitatively estimate white matter integrity. For each participant, determination of neonatal AKI was made via KDIGO urine output parameters ( < 0.5mL/kg/hr for ≥ 6 hours). A cohort of healthy, age-matched children without history of prematurity was also included for comparison. Study protocols received IRB approval and participant’s proxies provided informed consent for participation. Mann Whitney U tests will be used to compare pertinent NICU history data. ANOVA with Bonferroni corrections will be used to compare regional brain white matter integrity (e.g., fractional anisotropy (FA)) outcomes between those with history of neonatal AKI, those without neonatal AKI, and healthy controls. Chart reviews have been completed. We are currently completing analysis of clinical data in parallel with neuroimaging data. Analyses will be completed prior to April 2024.
