Perinatal risk factors and 2-year neurodevelopmental outcome of early acute kidney injury in very preterm and very low birth weight infants

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BACKGROUND: Acute kidney injury (AKI) is a significant complication for preterm infants, impacting both short- and long-term outcomes. This study aimed at identifying perinatal risk factors associated with early AKI and evaluating AKI's impact on long-term outcomes. METHODS: This retrospective cohort included 339 infants (born < 32 weeks gestational age or < 1500 g birth weight) admitted to a Level IV NICU between 2013 and 2017. AKI was defined either by serum creatinine (SCr) or urine output (UO) criteria. We examined gestational age, birth weight, perinatal factors, and medications (non-steroidal anti-inflammatory drugs [NSAIDs], inotropes) as predictors. Outcomes included early AKI, length of stay, growth at discharge, and neurodevelopment at 12 and 24 months corrected age. Univariate and multivariate logistic regression identified AKI risk factors, while linear regression assessed AKI's impact on neurodevelopment. RESULTS: AKI incidence varied by definition: AKI-SCr 42%, AKI-UO 7%. For AKI-SCr, extremely low birth weight (ELBW, OR 2.96, p = 0.002), NSAIDs (OR 2.14, p = 0.037), and inotropes (OR 2.26, p = 0.026) increased risk. Maternal hypertension (OR 0.51, p = 0.038) and female sex (OR 0.56, p = 0.037) were protective. For AKI-UO, ELBW (OR 6.52, p = 0.006) and inotropes (OR 3.60, p = 0.04) were the only risk factors. AKI-UO was linked to lower growth Z-scores and longer hospitalization. The relationship between AKI and poorer neurodevelopment disappeared after adjusting for neonatal comorbidities. CONCLUSIONS: Neonatal early AKI incidence and risk factors depend on diagnostic criteria. Low gestational age, birth weight, and drug exposure are key risk factors. Refining AKI definitions and conducting longitudinal outcome studies are essential.

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