Neonatal Nephrology/AKI
Neonatal Nephrology/AKI 2
Andrew F. Schiff, MD
Attending Neonatologist
Pediatrix Medical Group of Columbia, South Carolina
Mount Airy, North Carolina, United States
Prematurity and very low birth weight (VLBW) are risk factors for chronic kidney disease. Exposure to nephrotoxic antimicrobials, common in the NICU, may further increase this risk, however the association between the duration of concurrent exposure to multiple nephrotoxic antimicrobials and future kidney health is unknown.
Objective: Determine whether duration of concurrently administered nephrotoxic antimicrobials in the NICU contributes to worse long-term kidney health. We hypothesized that greater duration of exposure to concurrent antimicrobials is associated with worse kidney function in adolescents born preterm with VLBW.
Design/Methods: The Prenatal Events-Postnatal Consequences study is a prospective cohort of participants aged 14 years born preterm with VLBW (< 1500 grams) as singletons between January 1, 1992 and June 30, 1996. Exposures were duration of concurrent administration of high-risk with low-risk nephrotoxic antimicrobials (Table 1) during the NICU hospitalization. Outcomes were serum creatinine, estimated glomerular filtration rate, and first-morning urine albumin-creatinine ratio (ACR) at age 14 years. We fit multivariable linear regression models with the number of days of exposure to vancomycin or any high-risk antimicrobial by itself and the number of days of concurrent exposure to vancomycin or any high-risk antimicrobial and any low-risk antimicrobial as main effects, adjusting for gestational age, birth weight, and birth weight z-score, and used Random Forest imputation for missing data.
Results:
Of the 147 out of 177 participants who had exposure data, 97% received concurrent high-risk and low-risk antimicrobials for mean duration 7.2 days (SD 5.6). After adjustment, each day of concurrent exposure was associated with a 1.04-mg/g higher ACR (95% CI 1.01 to 1.06).
Conclusion(s):
In our cohort of youth born preterm with VLBW, each day of concurrent exposure to high-risk and low-risk antimicrobials in the NICU was associated with worse ACR in adolescence. Our findings provide long-term evidence supporting continued NICU antibiotic stewardship to protect future kidney health.