Incidence of Acute Kidney Injury by Neonatal RIFLE Criteria in NICU

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Napat Laoaroon
Pakaphan Kiatchoosakun
Suwannee Wisanuyotin
Apichat Jiravuttipong
Junya Jirapradittha
Sunee Panombualert


Background and objective: Acute kidney injury (AKI) is an important contributing factor to the mortality of critically ill neonates. However, the standardized AKI for this population is still inconclusive until neonatal RIFLE score has been proposed in 2013. This study aimed to identify the incidence of AKI in critically ill neonates by using neonatal RIFLE.

Methods: In this descriptive, retrospective study included all neonates admitted to the tertiary care NICU during January 2013-December 2014. The patient demographics, co-morbidities, and outcomes data were recorded. AKI was classified by neonatal RIFLE into urine output-based criteria and serum creatinine-based criteria. The objectives were 1. To determine the incidence of AKI as defined by neonatal RIFLE score in NICU. 2. To identify factors affecting AKI in critically ill neonates.

Results: A total of 263 neonates were enrolled. The incidence of AKI by neonatal RIFLE was 24.3%, compared with 8% of those diagnosed by attending physicians (p<0.001). Forty-eight of 64 patients (75%) with AKI were classified by urine output criteria only, eight patients (12.5%) were diagnosed by eGFR criteria only and eight patients (12.5%) matched both criteria. Congenital heart diseases and administration of vancomycin were found to be significant independent factors of AKI in the NICU (p<0.05). Most neonates with AKI (81.3%) had complete renal recovery. The mortality rate of neonates with AKI by neonatal RIFLE was 26.5% compared to 4% of neonates without AKI. 

Conclusion: The incidence of neonatal AKI by using urine output criteria from neonatal RIFLE was high (24%) and useful to detect and early management of neonatal AKI.


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