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Risk factors for acute kidney injury in neonates with congenital diaphragmatic hernia

Journal of Perinatology volume 41, pages 1901–1909 (2021)Cite this article

Subjects

Abstract

Objective

To examine incidence of acute kidney injury (AKI), antenatal and postnatal predictors, and impact of AKI on outcomes in infants with congenital diaphragmatic hernia (CDH).

Study design

Single center retrospective study of 90 CDH infants from 2009–2017. Baseline characteristics, CDH severity, possible AKI predictors, and clinical outcomes were compared between infants with and without AKI.

Result

In total, 38% of infants developed AKI, 44% stage 1, 29% stage 2, 27% stage 3. Lower antenatal lung volumes and liver herniation were associated with AKI. Extracorporeal life support (ECLS), diuretics, abdominal closure surgery, hypotension, and elevated plasma free hemoglobin were associated with AKI. Overall survival was 79%, 47% with AKI, and 35% with AKI on ECLS. AKI is associated with increased mechanical ventilation duration and length of stay.

Conclusion

AKI is common among CDH infants and associated with adverse outcomes. Standardized care bundles addressing AKI risk factors may reduce AKI incidence and severity.

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Fig. 1: Incidence and Timing of AKI.
Fig. 2: Effects of AKI on Selected Long-term Outcomes.

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Acknowledgements

We acknowledge John Kinsella, MD and Ken Liechty, MD for their knowledge, expertise, and contribution to the care of these complex patients as part of the CDH team at Children’s Hospital Colorado.

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Authors and Affiliations

  1. Department of Pediatrics, Section of Neonatology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Brianna M. Liberio, Megan J. Kirkley & Jason Gien

  2. Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA

    John T. Brinton

  3. Department of Pediatrics, Section of Cardiology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Katja M. Gist

  4. Department of Pediatrics, Section of Nephrology, Children’s Hospital Colorado, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Danielle E. Soranno

  5. Department of Pediatrics, Denver Health Medical Center, Denver, CO, USA

    Megan J. Kirkley

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  1. Brianna M. Liberio
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  4. Danielle E. Soranno
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  6. Jason Gien
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Contributions

KMG, DES, MJK, and JG conceptualized and designed the study. BML, MJK, and JG acquired the data, and BML, JTB, and JG analyzed the data. BML, JTB, KMG, and JG interpreted the data. BML, JTB, and JG drafted the paper. All authors revised the paper. All authors approved the final version of the manuscript and agreed to be accountable for all aspects of the work.

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Correspondence to Brianna M. Liberio.

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The authors declare no competing interests.

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Liberio, B.M., Brinton, J.T., Gist, K.M. et al. Risk factors for acute kidney injury in neonates with congenital diaphragmatic hernia. J Perinatol 41, 1901–1909 (2021). https://doi.org/10.1038/s41372-021-01119-1

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