Evaluation of risk factors associated with acute kidney injury in a level IV regional NICU

Background: Intervening on neonates at risk for developing acute kidney injury (AKI) improves safety and clinical outcomes. This study sought to evaluate risk factors associated with AKI in a level IV neonatal intensive care unit (NICU). Methods: Single-center, case-control study of patients with corrected gestational age (GA) <= 44 weeks from 2018 to 2022. Cases were those that developed AKI after day 4 of life. Controls were the next neonate admitted to the same NICU team that met inclusion criteria but did not develop AKI. Neonatal and maternal factors, nephrotoxic medication administration, and procedures were analyzed to identify risk factors associated with AKI using univariate and multivariate analyses. Results: A total of 94 patients were included: 47 cases and 47 controls. GA <27 weeks, birth weight <1500 grams, low APGAR score, intubation at birth, bronchopulmonary dysplasia (BPD), patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), and sepsis were associated with AKI on univariate analysis. Most cases (89.4%) had >4 risk factors, and this was associated with a 13.1-fold increase in the odds of developing AKI. Multivariate analysis identified GA <27 weeks (OR 7.7, 95% CI 1.7-34.4), vasopressor and/or inotrope administration (OR 4.4, 95% CI 1.2-23.8), and diagnosis of PDA (OR 6.9, 95% CI 1.5-31.3) as independent predictors of AKI. Conclusions: Risk factors associated with AKI were identified, and a 13.1-fold increase in AKI was found when >4 risk factors were present. This information may be used to expand renal acuity surveillance programs focusing on high-risk medication evaluation, demographic, and clinical factors.