233 - Low incidence of Acute Kidney Injury in Very Low Birth Weight (VLBW) infants treated with early high dose caffeine

Acute kidney injury (AKI) is common in neonates and associated with increased morbidity and mortality, longer hospitalization, and a higher risk of future kidney damage. The reported incidence of AKI among neonates with very low birth weight (VLBW; < 1500g) is 18% to 40%. Most AKI episodes occur during the first week. The incidence of early AKI (< 7 days) is between 14 to 22.5%. Caffeine treatment, commonly used to treat apnea of prematurity, was reported to be associated with decreased AKI occurrence. However, in these studies there was a lack of uniformity regarding the dosage and timing of the administration of the drug.


Objective:

To assess the incidence of AKI in VLBW preterm infants treated with early high dose caffeine, and to identify risk factors associated with AKI.

Design/Methods:

A retrospective cohort study of very low birth weight preterm infants admitted to the Neonatal Intensive Care Unit (NICU)  between Jan. 1, 2017 to Dec. 31, 2019. Acute kidney injury was based on elevation of serum creatinine levels or a decrease in urine output. AKI severity was defined according to the neonatal AKI KDIGO classification (Table 1) . High dose caffeine (20mg/kg bolus followed with a maintenance dose of 10 mg/kg/day) was universally given to all VLBW preterm infants born less than 32 weeks gestation. Infants with inadequate data on urine output or less than two creatinine measurements were excluded.

Results:

During the study period 311 VLBW infants were admitted. All had adequate creatinine and urine output data. 301 met the inclusion criteria. 41 infants (13.6%) were diagnosed with AKI, only 12 (4%) during the first week of life, significantly lower as compared to previous reports (p -value < 0.0001). 16 (5.1%) had more than one AKI episode 16 newborns (39%) had two or more events. Seven infants (17%) had AKI stage 1 and 17 infants   had stage 2 and 3 (41.5%). Table 2 describes differences in patients' characteristics and comorbidities comparing those with and without AKI. After adjusting for multiple variables, AKI was associated with lower gestational age and male sex (p value =0.002 and 0.03, respectively). VLBW infants with AKI were more likely to develop typical preterm morbidities. (Fig. 1) 

Conclusion(s):

The incidence of AKI in a cohort of VLBW infants, treated with early high dose caffeine was significantly lower as compared to incidence reported in previous studies, especially in the first week of life.