The incidence and outcomes of acute kidney Injury in critically-ill neonates at Chris Hani Baragwanath Academic Hospital: a prospective descriptive study

Abstract

Background: Acute kidney injury (AKI) is common in critically ill, hospitalized neonates. Scarce epidemiological data exist on AKI in children in South Africa. This study aimed to determine the incidence and outcomes of AKI in critically ill neonates. Methods This single-centre, prospective, observational study was conducted in the neonatal unit of the tertiary hospital Chris Hani Baragwanath Academic Hospital in South Africa. Neonates with AKI were recruited over a three-month period in 2019. AKI was defined using the AKIN criteria. Risk factors and demographic data were collected for all study participants. Study patients were followed up over the period to observe an outcome of either recovery or death. Results Fifty-one patients were enrolled. The incidence of AKI was 7.8% (95% CI, 5.9to 10.2%). The overall mortality of enrolled patients was 29.4% (95% CI, 26.3 to 56.1%), while the mortality rate of enrolled patients with worsening AKI before death was 19.6%. Mortality was significantly associated with extremely low birth weight (OR 11.4, p<0.01), umbilical catheterisation (OR 6.3, p=0.01), sepsis (OR 5.4, p=0.01), phototherapy (OR 4.4, p=0.03) and prematurity (p=0.04). The most frequent risk factor associated with AKI was intravenous nephrotoxic medication. Conclusion The incidence of AKI in our study was higher than expected. Further epidemiological and interventional studies are warranted.