Kidney Week

Abstract: FR-PO041

Relationship of Surgical Type and Fluid Balance with Noncardiac, Perioperative AKI in Neonates

Session Information

• AKI: Epidemiology, Risk Factors, and Prevention - 2
  October 25, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

• Beebe, Morgan Elizabeth, Nationwide Children's Hospital, Columbus, Ohio, United States

Morgan Elizabeth Beebe, MD

• Klamer, Brett, The Ohio State University College of Medicine, Columbus, Ohio, United States

Brett Klamer, MS

• Miller, Rain, The University of Toledo College of Medicine and Life Sciences, Toledo, Ohio, United States

Rain Miller

• Slaughter, Jonathan L., Nationwide Children's Hospital, Columbus, Ohio, United States

Jonathan L. Slaughter, MD, MPH

• Mohamed, Tahagod, Nationwide Children's Hospital, Columbus, Ohio, United States

Tahagod Mohamed, MD

Background

Few studies examine the relationship between noncardiac surgeries and neonatal acute kidney injury (AKI), with fewer focusing on the effects of fluid balance. Our study aims to evaluate the odds of noncardiac, peri-operative AKI development in neonates based on surgery class and fluid balance at our institution.

Methods

This is a retrospective review of neonates admitted to the neonatal intensive care unit at a single center from Nov 14-Jan 22. Neonates who required a major, minor, or procedural noncardiac surgery in the first 28 days of life were included for analysis. Neonates requiring cardiac surgery, ECMO, lethal chromosomal abnormality, or with significant underlying renal disease were excluded from analysis. Data were evaluated for the development of AKI in the 72 hours following intervention according to revised neonatal Kidney Disease: Improving Global Outcomes (nm:KDIGO) criteria for serum creatinine and urine output. We also reviewed the relationship between peri-operative fluid balance and AKI. Descriptive statistics were used to summarize patient characteristics. Statistical significance was set at an alpha level of 0.05.

Results

764 neonates were included for final analysis. Following intervention, 715(94%) of neonates did not develop AKI, while 49(6%) did. A more positive fluid balance in the peri-operative period was associated with AKI development on POD 1,2, and 3 (p=0.003,0.002,0.023, respectively). In multivariate logistic regression, the odds of perioperative AKI were significantly higher in neonates undergoing minor surgeries compared procedures. Statistical significance was achieved between the odds of developing AKI in neonates undergoing minor surgery vs procedures [OR 0.52(0.15-1.36);OR 0.19(0.01-0.94), respectively], with a higher odds ratio of AKI after a minor surgery.

Conclusion

In this single-center retrospective analysis, we seek to evaluate associations between AKI and other variables within 72 hours of surgery. Significant factors associated with AKI include a more positive fluid balance, with a higher odds of AKI development in neonates undergoing minor surgery compared to a procedure. AKI surveillance should be undertaken in neonates undergoing noncardiac surgeries, with special attention to fluid balance peri-operatively to further reduce risk of AKI development.