Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease

Kurt D Piggott; Meshal Soni; William M Decampli; Jorge A Ramirez; Dianna Holbein; Harun Fakioglu; Carlos J Blanco; Kamal K Pourmoghadam

doi:10.1177/2150135115586814

Acute Kidney Injury and Fluid Overload in Neonates Following Surgery for Congenital Heart Disease

World J Pediatr Congenit Heart Surg. 2015 Jul;6(3):401-6. doi: 10.1177/2150135115586814.

Authors

Kurt D Piggott¹, Meshal Soni², William M Decampli³, Jorge A Ramirez⁴, Dianna Holbein⁵, Harun Fakioglu⁶, Carlos J Blanco⁵, Kamal K Pourmoghadam³

Affiliations

¹ Pediatric Cardiac Intensive Care, The Heart Center at Arnold Palmer Hospital for Children, University of Central Florida College of Medicine, Orlando, FL, USA kurt.piggott@orlandohealth.com.
² University of Central Florida, Orlando, FL, USA.
³ Pediatric Cardiothoracic Surgery, The Heart Center at Arnold Palmer Hospital for Children, University of Central Florida College of Medicine, Orlando, FL, USA.
⁴ Arnold Palmer Hospital for Children Hewell Kids Kidney Center, University of Central Florida College of Medicine, Orlando, FL, USA.
⁵ Pediatric Cardiac Intensive Care, The Heart Center at Arnold Palmer Hospital for Children, Orlando, FL, USA.
⁶ Pediatric Cardiac Intensive Care, The Heart Center at Arnold Palmer Hospital for Children, University of Central Florida College of Medicine, Orlando, FL, USA.

PMID: 26180155
DOI: 10.1177/2150135115586814

Abstract

Background: Acute kidney injury (AKI) and fluid overload have been shown to increase morbidity and mortality. The reported incidence of AKI in pediatric patients following surgery for congenital heart disease is between 15% and 59%. Limited data exist looking at risk factors and outcomes of AKI or fluid overload in neonates undergoing surgery for congenital heart disease.

Methods: Neonates aged 6 to 29 days who underwent surgery for congenital heart disease and who were without preoperative kidney disease were included in the study. The AKI was determined utilizing the Acute Kidney Injury Network criteria.

Results: Ninety-five neonates were included in the study. The incidence of neonatal AKI was 45% (n = 43), of which 86% had stage 1 AKI. Risk factors for AKI included cardiopulmonary bypass time, selective cerebral perfusion, preoperative aminoglycoside use, small kidneys by renal ultrasound, and risk adjustment for congenital heart surgery category. There were eight mortalities (five from stage 1 AKI group, three from stage 2, and zero from stage 3). Fluid overload and AKI both increased hospital length of stay and postoperative ventilator days.

Conclusion: To avoid increased risk of morbidity and possibly mortality, every attempt should be made to identify and intervene on those risk factors, which may be modifiable or identifiable preoperatively, such as small kidneys by renal ultrasound.

Keywords: acute kidney injury; congenital heart disease; fluid overload; heart surgery; neonate; pediatric.

MeSH terms

Acute Kidney Injury / diagnosis
Acute Kidney Injury / etiology*
Early Diagnosis
Epidemiologic Methods
Female
Heart Defects, Congenital / surgery*
Humans
Infant
Infant, Newborn
Intensive Care, Neonatal
Male
Postoperative Complications / diagnosis
Postoperative Complications / etiology*
Risk Factors
Time Factors
Treatment Outcome
Water-Electrolyte Imbalance / diagnosis
Water-Electrolyte Imbalance / etiology*