Neurodevelopment After Neonatal Acute Kidney Injury in Very Preterm-Birth Children

Chih-Chia Chen; Chi-Hsiang Chu; Yung-Chieh Lin; Chao-Ching Huang

doi:10.1016/j.ekir.2023.06.020

Neurodevelopment After Neonatal Acute Kidney Injury in Very Preterm-Birth Children

Kidney Int Rep. 2023 Jul 3;8(9):1784-1791. doi: 10.1016/j.ekir.2023.06.020. eCollection 2023 Sep.

Authors

Chih-Chia Chen^{1

2}, Chi-Hsiang Chu³, Yung-Chieh Lin², Chao-Ching Huang^{2

4}

Affiliations

¹ Graduate Institute of Clinical Medicine, College of Medicine, National Cheng-Kung University, Tainan, Taiwan.
² Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
³ Department of Statistics, Tunghai University, Taichung, Taiwan.
⁴ Department of Pediatrics, College of Medicine, Taipei Medical University, Taipei, Taiwan.

Abstract

Introduction: This study aimed to assess head circumference (HC) growth and neurodevelopmental outcomes in very preterm-birth children after neonatal acute kidney injury (AKI).

Methods: This longitudinal follow-up cohort included 732 very preterm neonates of gestational age <31 weeks admitted to a tertiary center between 2008 and 2020. AKI was categorized as nonoliguric and oliguric AKI based on the urine output criteria during admission. We compared the differences in death, z scores of HC (zHC) at term-equivalent age (TEA) and at corrected ages of 6, 12, and 24 months, and the neurodevelopmental outcomes at corrected age of 24 months after neonatal nonoliguric and oliguric AKI.

Results: Among the 154 neonates who developed AKI, 72 had oliguric AKI and 82 had nonoliguric AKI. At TEA, oliguric AKI, but not nonoliguric AKI, was independently associated with lower zHC than non-AKI (mean differences, -0.49; 95% confidence interval [CI], -0.92 to -0.06). Although the 3 groups were comparable in zHC at corrected ages of 6, 12, and 24 months, the oliguric AKI group, but not the nonoliguric AKI group, had a higher rate of microcephaly by corrected age of 24 months. In addition, the oliguric AKI group, but not the nonoliguric AKI group, was more likely to die (61% vs. 9%) and have neurodevelopmental impairment (41% vs. 14%) compare with the non-AKI group. After adjustment, oliguric (adjusted odds ratio [aOR], 8.97; 95% CI, 2.19-36.76), but not nonoliguric, AKI was associated with neurodevelopmental impairment.

Conclusion: Neonatal oliguric AKI is associated with neurodevelopmental impairment in very preterm-birth children. Long-term head-size and neurodevelopmental follow-up after neonatal AKI is warranted.

Keywords: acute kidney injury; head growth; neonates; neurodevelopment; oliguria; very preterm infants.