007 - Is Neonatal Acute Kidney Injury an Independent Risk Factor For Poor Neurodevelopmental Outcomes in ELGANs 22 0/7 – 27 6/7?

Publication Number: 7.5597

Dayle J. Bondarev, Sutter Santa Rosa Regional Hospital, Petaluma, CA, United States; Deanne Wilson-Costello, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Anna Maria Hibbs, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States; Emily L. Joyce, UH Rainbow Babies & Children's Hospital, Highland Hts, OH, United States; Nori M. Minich, Case Western Reserve University School of Medicine, Cleveland, OH, United States; Sindhoosha Malay, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States; Monika Bhola, UH Rainbow Babies & Children's Hospital, Cleveland, OH, United States

Background: The overall incidence of acute kidney injury (AKI) in the Assessment of Worldwide Acute Kidney injury Epidemiology in Neonates (AWAKEN) study was 29.9% with it being 48 % for infants born at 22-29 weeks gestational age (wga). Those with AKI had > 4-fold higher independent odds of death and longer independent hospital stay. While several morbidities of extreme prematurity have been shown to be independently associated with poor neurodevelopmental outcomes, the long-term neurodevelopmental effects following AKI in preterm neonates have not been fully studied.

Objective: The purpose of this study is to determine whether neonatal AKI is independently associated with poor neurodevelopmental outcomes follow-up at 18-24 months in infants born at 22 0/7 - 27 6/7 wga.

Design/Methods: This was a single center retrospective chart review of infants born at ≤ 27 6/7 wga. Maternal and neonatal characteristics were obtained through electronic medical records. Neurodevelopmental impairment analysis was performed by a pediatric development and behavioral psychologist using the Bayley Scales of Infant Development III. Neurodevelopmental impairment (NDI) < 85 or death is defined as neurodevelopmental impairment with Bayley motor, language or cognitive score of < 85 or blindness, or deafness, or death. AKI was defined according to the Kidney Disease: Improving Global Outcomes modified for neonates adapted from the AWAKEN study.

Results: 369 infants were included in the study. The incidence of AKI is 55% and incidence of NDI < 85 or death is 86.7%. In the univariable analysis, AKI demonstrates a significant association with NDI < 85 or death. In contrast, the multivariable analysis showed that AKI did not exhibit an association with NDI < 85 or death after adjusting for SNAP scores, public insurance, race, presence of PDA, NEC/SIP, IVH >3 or 4 or PVL and sepsis.

Conclusion(s): To date, this is one of the largest studies on premature neonatal kidney injury, that assessed its association with neurodevelopmental impairment. In this extensive retrospective analysis of a single-center cohort of extremely low gestational age neonates born between 22 0/7 and 27 6/7 weeks of gestation, AKI was initially found to be univariately associated with NDI or mortality. However, after adjusting for relevant covariates, this association was no longer observed. These findings are consistent with AKI being a marker of severity of illness but not having a direct causal effect on NDI.

Maternal and Neonatal Demographics
Table 1 - Demographics.pdfThis table provides maternal and neonatal demographics included in this data analysis.

Neurodevelopmental Impairment
Table 2 - NDI.pdfThis table provides the incidence of NDI.

Neurodevelopmental Impairment <85 or Death
Table 3 - NDI <85.pdfTable 3 provides a comparative analysis of maternal and neonatal characteristics between two cohorts of infants: those with neurodevelopmental impairment (NDI) scores below 85 or who deceased. The table includes both univariable and multivariable analyses, detailing their respective odds ratios (OR), confidence intervals (CI), and p-values.

Maternal and Neonatal Demographics
Table 1 - Demographics.pdfThis table provides maternal and neonatal demographics included in this data analysis.

Neurodevelopmental Impairment
Table 2 - NDI.pdfThis table provides the incidence of NDI.

Neurodevelopmental Impairment <85 or Death
Table 3 - NDI <85.pdfTable 3 provides a comparative analysis of maternal and neonatal characteristics between two cohorts of infants: those with neurodevelopmental impairment (NDI) scores below 85 or who deceased. The table includes both univariable and multivariable analyses, detailing their respective odds ratios (OR), confidence intervals (CI), and p-values.