Background

We assessed the incidence of and risk factors for acute kidney injury (AKI) in very low birthweight infants (VLBW) in a center with a specific neonatal management protocol focusing on avoidance of early mechanical ventilation (MV).

Methods

This retrospective single center analysis includes 128 infants born in 2020 with a gestational age ≥ 22 weeks who were screened for AKI using the nKDIGO criteria.

Results

AKI was identified in 25/128 patients (19.5%) with eight of them (6.3%) presenting with severe AKI. Low gestational age, birthweight and 10-minute Apgar score as well as high CRIB-1 score were all associated with incidence of AKI. Forty-five percent of the infants with MV developed AKI vs. 8.9% of those without MV (p < 0.001). Early onset of MV and administration of more than 3 dosages of NSAIDs for patent duct were identified as independent risk factors for AKI in a logistic regression analysis.

Conclusions

We report a substantially lower frequency of AKI in VLBW infants as compared to previous studies, along with a very low rate of MV. A neonatal protocol focusing on avoidance of MV within the first days of life may be a key factor to decrease the risk of AKI in immature infants.

Graphical abstract

中文翻译：

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限制使用机械通气的 VLBW 婴儿急性肾损伤发生率较低

背景

我们评估了中心极低出生体重婴儿 (VLBW) 急性肾损伤 (AKI) 的发生率和危险因素，该中心采用了侧重于避免早期机械通气 (MV) 的特定新生儿管理方案。

方法

这项回顾性单中心分析包括 128 名 2020 年出生、胎龄≥ 22 周的婴儿，他们使用 nKDIGO 标准进行了 AKI 筛查。

结果

25/128 名患者 (19.5%) 发现 AKI，其中 8 名 (6.3%) 出现严重 AKI。低胎龄、出生体重和10分钟Apgar评分以及高CRIB-1评分均与AKI的发生率相关。患有 MV 的婴儿中有 45% 发生 AKI，而无 MV 的婴儿中这一比例为 8.9% ( p  < 0.001)。在逻辑回归分析中，MV 早期发作和导管未闭使用超过 3 剂 NSAID 被确定为 AKI 的独立危险因素。

结论

我们报告，与之前的研究相比，VLBW 婴儿中 AKI 的发生率显着降低，并且 MV 的发生率也非常低。注重在出生后几天内避免 MV 的新生儿方案可能是降低未成熟婴儿 AKI 风险的关键因素。

图形概要