027 - Perinatal Risk Factors for Acute Kidney Injury in Extremely Low Gestational Age Neonates

Publication Number: 27.6315

Lauren R. Kee, Southern Illinois University School of Medicine, Springfield, IL, United States; Hannah Johnson, Southern Illinois University School of Medicine, Springfield, IL, United States; Maha S. Majjiga, University of Illinois Chicago, Chatham, IL, United States; Erin M. Bauer, Southern Illinois University School of Medicine, Springfield, IL, United States; Kaniz F. Priyanka, Southern Illinois University School of Medicine, Springfield, IL, United States; Andrew T. Fields, Southern Illinois University School of Medicine, Springfield, IL, United States; Mohamed F. Ahamed, SIU Medicine, Springfield, IL, United States

Background: Extremely low gestational age neonates (ELGAN) are at increased risk of acute kidney injury (AKI) which is associated with increased mortality and poor outcomes. Maternal perinatal risk factors such as socioeconomic disadvantage, young or advanced maternal age, renal disease, alcohol or tobacco consumption, chronic hypertension, and preeclampsia have been associated with increased risk of prematurity. However, the direct relationship between many of these maternal risk factors with the development of AKI in ELGAN is not clearly established.

Objective: To explore factors associated with AKI and determine the impact of medical and social maternal and perinatal risk factors on the development of AKI in ELGAN in the first 14 postnatal days.

Design/Methods: Retrospective cohort study of all ELGAN (23 0/7-27 6/7 weeks GA) at a regional perinatal center/level III NICU (ADC 45, >700 annual admissions) over a 6-year period (4/2018-5/2024). Infants with and without AKI were classified based on neonatal modified KDIGO definition of AKI. Data analyzed included demographics, clinical variables, in-hospital outcomes, growth velocity, and medical and socioeconomic perinatal risk factors. Data was analyzed using Mann Whitney U test for continuous variables, Chi-square test for categorical variables, and independent t-test for quantitative variables. After appropriate statistical analysis, p < 0.05 was considered significant.

Results: 46 neonates with AKI were compared to 140 neonates without AKI. When compared to controls, infants with AKI are found to be less mature, have lower birth weight, require prolonged mechanical ventilation, and utilize more inotropes. Infants with AKI are also more likely to be born with growth restriction (Table 1). Other perinatal risk factors do not correlate with increased risk of AKI. These include race (p=0.28), maternal education (p=0.34), insurance status (p=0.32), adequacy of prenatal care (p=0.65), gestational diabetes (p=0.48), hypertension (p=0.46), use of assisted reproductive techniques (p=0.22), use of NSAIDs/ACE-inhibitors/ARBs, substance abuse (p=0.35), abnormal placental pathology (p=0.27), preterm labor (p=0.12), presence of single umbilical artery (p=0.32), maternal renal disease (p=0.96), and maternal age at infant birth (p=0.33).

Conclusion(s): Infants with AKI are less mature and more likely to have growth restriction. They require more inotropic support and prolonged mechanical ventilation. Socioeconomic and medical perinatal risk factors are not associated with the development of AKI in ELGAN despite increasing the risk of premature birth.

Table 1: Perinatal variables and clinical outcomes in infants with and without AKI
*p- value <0.05 is significant