Risk factors of acute kidney injury in extremely low gestational age neonates (ELGANs) - a retrospective case-control study

BackgroundNeonatal acute kidney injury (AKI) is associated with poor clinical outcomes. Consequently, this study was designed to explore the prenatal and postnatal risk factors in Chinese extremely low gestational age neonates (ELGANs).MethodsThis retrospective study included all ELGANs (born between 23-0/7 and 27-6/7 weeks of gestation) hospitalized from January 2019 to December 2022. These premature babies were divided into the AKI group (n = 39) and the non-AKI group (n = 76) according to the Kidney Disease: Improving Global Outcomes (KDIGO) criteria.ResultsAKI most frequently occurred in the first 10 days of life (median: 8th day, quartile range: 6th - 10th day). Most infants (61.54%) manifested stage 1 AKI. Lower gestational age (GA) was the major independent risk factor for AKI [adjusted OR (aOR): 0.40, 95% CI: 0.22-0.67]. Moreover, the lower the GA, the higher the risk of AKI. When the interactive effect between GA and nonsteroidal anti-inflammatory drugs (NSAIDs) was considered, NSAIDs administration would greatly enhance the risk of AKI (interaction term, aOR: 3.94, 95% CI: 1.26-13.92). The levels of serum creatinine and urea nitrogen in the AKI group generally returned to normal upon discharge and continued until 6 months after follow-up.ConclusionWhen using NSAIDs in the ELGANs population, great attention should be paid to dynamically monitor kidney function.Graphical abstract A higher resolution version of the Graphical abstract is available as A higher resolution version of the Graphical abstract is available as Supplementary information