217 - Perinatal Risk Factors Associated with Severe Acute Kidney Injury Duration Among Extremely Low Gestational Age Newborns: a secondary analysis of the Preterm Erythropoietin Neuroprotection Trial

Saturday, April 29, 2023

3:30 PM – 6:00 PM ET

Poster Number: 217
Publication Number: 217.242

Keia Sanderson, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States; Nekayla Anderson, UAB, Birmingham, AL, United States; Russell Griffin, University of Alabama at Birmingham, Birmingham, AL, United States; Andrew M.. South, Wake Forest School of Medicine of Wake Forest Baptist Medical Center, Winston Salem, NC, United States; Jonathan R. Swanson, University of Virginia School of Medicine, Charlottesville, VA, United States; Michael Zappitelli, The Hospital for Sick Children, Toronto, ON, Canada; Heidi J.. Steflik, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Marissa JANEL. DeFreitas, University of Miami Leonard M. Miller School of Medicine, Miami, FL, United States; Jennifer R. Charlton, University of Virginia, Charlottesville, VA, United States; David Askenazi, University of Alabama at Birmingham, BIRMINGHAM, AL, United States

Presenting Author(s)

KS

Keia Sanderson, MD, MSc

Assistant Professor of Medicine and Pediatrics
University of North Carolina at Chapel Hill School of Medicine
Chapel Hill, North Carolina, United States

Background: Duration of acute kidney injury (AKI) is a significant predictor of end-stage kidney disease and death in adults. Perinatal risk factors which impact severe AKI duration have not been evaluated in infants.

Objective: To identify the perinatal factors associated with the duration of severe neonatal AKI among Extremely Low Gestational Age Newborns (ELGANs, < 28 weeks gestation).

Design/Methods:

This was a secondary analysis of the Preterm Erythropoietin Neuroprotection Trial study. ELGANs with severe AKI were included. ELGANs who died or were transferred within the first 7 days, or died prior to discharge were excluded.

Severe AKI duration was defined as the number of hospital days an infant met the modified Kidney Disease: Improving Global Outcomes stage 2-3 neonatal AKI criteria by serum creatinine (SCr). The baseline SCr was established as the lowest SCr after 24-48 hours of life. Severe AKI resolution days were excluded from the duration count and were defined as the days SCr decreased to less than 2 times the baseline SCr. All available SCr values were included prior to 44 weeks post menstrual age or neonatal intensive care unit (NICU) transfer or discharge.

A negative binomial regression model estimates count ratios for the association between all perinatal exposures and severe AKI duration among ELGANs. Neonatal factors occurred at birth or within 72 hours prior to severe AKI onset. Forest plots present results of the full models for all maternal and neonatal exposures.

Results:

159 (17.2%) infants of 923 had severe AKI and survived to NICU discharge/transfer. Median age at first severe AKI was 23 days (IQR 14-54). Median total duration of severe AKI was 6 days (IQR 2.6-21.4).

Maternal pregnancy induced hypertension, prenatal steroid exposures, infant vasopressor exposure, spontaneous intestinal perforation, sepsis, and delivery room exposures were significantly associated with a decreased number of severe AKI days (Figure 1).

Non-steroidal anti-inflammatory drug (NSAID) exposure (49% increased severe AKI duration; count ratio 1.49; 95% CI 1.1-2.1) and necrotizing enterocolitis (NEC) (64% increased severe AKI duration; count ratio 1.64; 95% CI 1.1-2.6) were significantly associated with an increased number of severe AKI days (Figure 2).

Conclusion(s): Several perinatal factors were associated with a greater duration of severe AKI. Future research directions include evaluating whether mitigating risk factors we’ve identified can reduce AKI duration and; evaluating if duration of severe AKI is more impactful at predicting long-term kidney disease in infants.