Acute Kidney Injury in Neonatal Sepsis: Risk Factors, Clinical Profile, and OutcomeFunding None.
17 April 2017
04 August 2017
11 December 2017 (eFirst)
Objective This study aims to determine the proportion of cases of neonatal sepsis developing acute kidney injury (AKI).
Methods This is a prospective observational study conducted in the nursery of a tertiary care center in Northern India during October 2012 to March 2014. Newborns with symptoms suggestive of sepsis were investigated. Those with congenital renal anomalies and negative for sepsis were excluded from the study. Newborns with sepsis were treated accordingly and observed for AKI until discharge or death. Acute Kidney Injury Network definition was used to define AKI in this study.
Results A total of 310 neonates with sepsis were enrolled out of which 3.87% neonates developed AKI. Factors such as maternal age, sex, birth weight, gestational age, asphyxia, the risk factor of sepsis in the mother, meconium-stained liquor, and mode of delivery were not found to be associated with AKI. Meningitis (p < 0.05) was found to be significantly associated with AKI. Duration of stay was longer for those with AKI (p < 0.01), but the mortality rate did not differ significantly among those with AKI and those without AKI. Around 25% of cases were found to be AKI stage 1, 25% of cases were AKI stage 2, and 50% of cases were AKI stage 3.
Conclusion It is difficult to predict AKI based on clinical features, so it is better to screen all the neonates with sepsis for AKI so that they can be managed accordingly, as AKI detected early has a better prognosis.
- 1 Kayange N, Kamugisha E, Mwizamholya DL, Jeremiah S, Mshana SE. Predictors of positive blood culture and deaths among neonates with suspected neonatal sepsis in a tertiary hospital, Mwanza-Tanzania. BMC Pediatr 2010; 10: 39
- 2 Chiabi A, Djoupomb M, Mah E. , et al. The clinical and bacteriological spectrum of neonatal sepsis in a tertiary hospital in Yaounde, Cameroon. Iran J Pediatr 2011; 21 (04) 441-448
- 3 Shehab El-Din EMR, El-Sokkary MMA, Bassiouny MR, Hassan R. Epidemiology of neonatal sepsis and implicated pathogens: A study from Egypt. BioMed Res Int 2015; 2015: 509484
- 4 Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008; 36 (05) 309-332
- 5 Mehta RL, Kellum JA, Shah SV. , et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11 (02) R31
- 6 NNPD Network. National Neonatal-Perinatal Database Report 2002–2003. New Delhi, India: NNPD Nodal Center at Department of Pediatrics, WHO Collaborating Centre Newborn Training & Research, All India Institute of Medical Sciences, New Delhi for National Neonatology Forum NNPD Network, India; 2005
- 7 Jain NK, Jain VM, Maheshwari S. Clinical profile of neonatal sepsis. Kathmandu Univ Med J 2003; 1 (02) 117-120
- 8 Sundaram V, Kumar P, Narang A. Blood culture confirmed bacterial sepsis in neonates in a north Indian tertiary care center: changes over the last decade. Jpn J Infect Dis 2009; 62 (01) 46-50
- 9 Sankar MJ, Agarwal R, Deorari AK, Paul VK. Sepsis in the newborn. Indian J Pediatr 2008; 75 (03) 261-266
- 10 Vinodkumar CS, Neelagund YF. Acinetobacter septicaemia in neonates. Indian J Med Microbiol 2004; 22 (01) 71
- 11 Mathur NB, Agarwal HS, Maria A. Acute renal failure in neonatal sepsis. Indian J Pediatr 2006; 73 (06) 499-502
- 12 Stoll BJ, Hansen N, Fanaroff AA. , et al. Changes in pathogens causing early-onset sepsis in very-low-birth-weight infants. N Engl J Med 2002; 347 (04) 240-247
- 13 Torkaman M, Afsharpaiman SH, Hoseini MJ. , et al. Platelet count and neonatal sepsis: a high prevalence of Enterobacter spp. Singapore Med J 2009; 50 (05) 482-485
- 14 Jayashree G, Saili A, Sarna MS, Dutta AK. Renal dysfunction in septicemic newborns. Indian Pediatr 1991; 28 (01) 25-29
- 15 Azat NF, Salih AA, Naoom MB. Acute renal failure in neonates. Iraqi Postgrad Med J 2011; 10: 145-148
- 16 Selewski DT, Charlton JR, Jetton JG. , et al. Neonatal acute kidney injury. Pediatrics 2015; 136 (02) e463-e473
- 17 Sutherland SM, Byrnes JJ, Kothari M. , et al. AKI in hospitalized children: comparing the pRIFLE, AKIN, and KDIGO definitions. Clin J Am Soc Nephrol 2015; 10 (04) 554-561