Aetiology and mortality predictors in critically ill neonates with acute kidney injury at a tertiary health centre: a prospective observational study

Background: In India, the incidence of acute kidney injury (AKI) ranges from 4.2% to 37.1%, with a 60% mortality in neonates.

Objectives: To determine the aetiology and outcome of AKI in critically ill neonates.

Method: A prospective observational study was undertaken on critically ill neonates who fulfilled the inclusion criteria at a tertiary institute for one year. AKI was diagnosed based on a plasma creatinine level >1.5mg/dl and the plasma creatinine was repeated at 72 hours and on the 7th day of diagnosis. Aetiology and risks of mortality were analysed.

Results: Male: female ratio was 1.55:1. Around 60% neonates were term and 64.6% had normal birth weight. Anaemia was the most common maternal illness followed by hypertension. Sepsis was associated with 60% neonates with AKI followed by dehydration (19.23%) and birth asphyxia (14.62%). All neonates with proven sepsis and HIE III succumbed. E. coli was the most common isolates in the septic neonate. The mortality rate was 33.1%. Presence of maternal anaemia, hypertension, oliguria, high mean serum creatinine, acidosis and hyponatraemia were related to a higher mortality. Likewise, presence of sepsis, shock, asphyxia, respiratory distress syndrome, use of mechanical ventilation and requirement of renal replacement therapy in neonates were significantly associated with high mortality. Presence of sepsis, birth asphyxia and use of mechanical ventilation were the independent risk factors of mortality.

Conclusions: Sepsis was most common aetiological factor for AKI followed by dehydration and birth asphyxia. The mortality rate was 33.1%. Sepsis, birth asphyxia and use of mechanical ventilation were the independent risk factors of mortality

Sri Lanka Journal of Child Health, 2021; 50(3): 377-384