Risk Factors And Outcome For Acute Kidney Injury In Very Low Birth Weight Infants

Objective:To investigate the risk factors for acute kidney injury in very low birth weight infants and risk factors for death of infants with AKI.Methods:A retrospective analysis was performed for the clinical data of 313 very low birth weight infants admitted to our neonatal diagnosis and treatment center from January 2012 to December 2016.According to neonatal modified KDIGO criteria,neonates were divided into AKI group and non-AKI group.According to the outcome of discharge,AKI infants were divided into death group and survival group.Statistical methods were used to analyze the risk factors for AKI and the risk factors for death of infants with AKI.The outcome of AKI were followed.Results:The incidence rate of AKI in very low birth weight infant was 40.3%(126/313),and 53 infants(42.1%)at stage 1,43 infants(34.1%)at stage 2,30 infants(23.8%)at stage 3.77.0%(97/126)of AKI occurred within 7 days after birth.AKI group and N-AKI group had significant differences in terms of gender,gestational age,birth weight,length,delivery method,5-minute Apgar score,age of mothers,occurrence of hypertension during pregnancy,premature rupture of membranes and asphyxia at birth.Comparison of comorbidities,AKI group and N-AKI group had significant differences in neonatal respiratory distress syndrome,respiratory failure,sepsis,intracranial hemorrhage,pulmonary hemorrhage,neonatal necrotizing enterocolitis,bronchopulmonary dysplasia and patent ductus arteriosus.Comparison of condition at admission and laboratory index,there were significant differences in white blood cell,procalcitonin,mean arterial pressure,critical score,albumin,and sodium between AKI group and N-AKI group.There were significant differences in the use of invasive mechanical ventilation,mechanical ventilation time,inhaled oxygen concentration and the use of pulmonary surfactant at the time of birth between AKI group and N-AKI group.Compared with nephrotoxic drugs during hospitalization,the AKI group and N-AKI group had significant differences in glycopeptide antibiotics,diuretics,antifungal drugs and inotropes.The gestational age(OR:0.74,95%CI:0.599~0.913,p=0.005),respiratory failure(OR:7.995,95%CI:3.092~20.466,p<0.001)and invasive mechanical ventilation at birth(OR:4.342,95%CI:2.052~9.191,p=0.041)were independent risk factors for AKI in VLBWI.There were significant differences between the death group and the survival group in PH,HCO3-,lactic acid,absolute value of BE,small for gestational age and complicated with pulmonary hemorrhage.The degree of metabolic acidosis(OR:0.811,95%CI:0.709~0.928,p=0.002)and concurrent pulmonary hemorrhage(OR:3.686,95%CI:1.389~9.780,p=0.009)were independent risks for death.Conclusion:The incidence and case fatality rate of acute kidney injury in very low birth weight infants were high,and more occurred within 7 days after birth.The lower gestational age,respiratory failure and invasive mechanical ventilation at birth increased the incidence of AKI in very low birth weight infants.The degree of metabolic acidosis,concurrent pulmonary hemorrhage increased the risk for death of infants with AKI.