Association of In-hospital outcome of Acute Kidney Injury (AKI) with etiology among newborns at a tertiary care unit

Objective: To determine association of in-hospital outcome of AKI with etiology in newborns at a tertiary care hospital.

Methods: This descriptive cross-sectional study was conducted at Department of Pediatric Neonatology, The Children’s Hospital and Institute of the Child Health, Multan by using non-probability purposive sampling technique from June 2016 to June 2017. A total of 101 newborns diagnosed with acute kidney injury were registered. Etiological factors were assessed and these patients were followed till discharge to monitor in-hospital outcomes.

Results: Of these 101 newborns, 75 (74.3%) were boys while 26 (25.7%) were girls. Mean age of these newborns was 7.59 ± 6.13 days (range; 1 day to 28 days). Mean age of the boys was 5.73 ± 7.20 days while that of girls was 6.77 ± 6.16 days. (p=0.515). Mean weight of these neonates was 2545.05 ± 600.42 grams (range; 1000 grams to 4000 grams). Mean serum potassium level was 4.94 ± 0.92 mgEq/L ranging from 3.1 mgEq/L to 7.0 mgEq/L. Mean urea level was 73.35 ± 27.65 mg/dl ranging from 18 mg/dl to 206 mg/dl. Mean serum creatinine level was 1.98 ± 0.27 mg/dl, ranging from 1.6 mg/dl to 2.8 mg/dl. Mean serum sodium level was 145.72 ± 12.64 mgEq/L ranging from 126 to 166 mEq/L. Eighty one (80.2%) were term babies while 20 (19.8%) were pre-term babies. Of these 101 study cases, 29 (28.7%) delivered vaginally while 72 (71.3%) through cesarean section. Delayed crying was noted in 48 (47.5%), dehydration 13 (12.9%), sepsis in 36 (35.6%) and renal malformation in only 4%. Neonatal mortality in these patients was 15 (14.9%) while 86 (85.1%) were discharged from hospital after recovery.

Conclusion: Acute kidney disease in newborns is associated with significant disease morbidity and mortality with asphyxia and sepsis are the main etiological factors responsible. It is predominantly more common in boys compared with girls. Mortality rate was high in our study and it was significantly associated with female gender. Mortality was also associated with elevated serum sodium and urea level.