Am J Perinatol
DOI: 10.1055/a-2161-7663
Original Article

Perioperative Neonatal Acute Kidney Injury Is Common: Risk Factors for Poor Outcomes

Tahagod H. Mohamed
1   The Division of Nephrology and Hypertension, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, Ohio
2   The Kidney and Urinary Tract Center, Nationwide Children's Hospital, Columbus, Ohio
Christian Mpody
3   Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
Olubukola Nafiu
3   Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio
› Author Affiliations
Funding None


Objective Perioperative acute kidney injury (AKI) is associated with poor patient outcomes. The epidemiology of perioperative AKI is characterized in children and to a lesser extent in neonates with cardiac disease. We hypothesized that the prevalence of noncardiac perioperative AKI in neonates is higher than in older children. We also hypothesized that certain neonatal characteristics and comorbidities increase the risk of perioperative AKI and hospital mortality. We aimed to characterize the epidemiology and risk factors of perioperative AKI in neonates undergoing noncardiac surgeries and outline the associated mortality risk factors.

Study Design We performed a retrospective study of neonates ≤28 days old who underwent inpatient noncardiac surgery in 46 U.S. children's hospitals participating in the Pediatric Hospital Information System between 2016 and 2021. AKI was evaluated throughout the surgical admission encounter. AKI was defined using the International Classification of Diseases (ICD) versions 9 and 10 codes. Comorbid risk factors are chronic and longstanding diagnoses and were selected using ICD-9 and ICD-10 diagnostic and procedure codes.

Results Perioperative AKI occurred in 10% of neonates undergoing noncardiac surgeries. Comorbidities associated with high risk of perioperative AKI included metabolic, hematologic/immunologic, cardiovascular, and renal disorders. The relative risk of mortality in perioperative AKI was highest in infants with low birthweight (relative risk = 1.49, 1.14–1.94) and those with hematologic (1.46, 1.12–1.90), renal (1.24, 1.01–1.52), and respiratory comorbidities (1.35, 1.09–1.67).

Conclusion Perioperative AKI is common in neonates undergoing noncardiac surgeries. Infants with high-risk comorbidity profiles for the development of perioperative AKI and mortality may benefit from close surveillance of their kidney function in the perioperative period. Although retrospective, the findings of our study could inform clinicians to tailor neonatal perioperative kidney care to improve short- and long-term outcomes.

Key Points

  • AKI is common in neonates undergoing noncardiac surgeries.

  • Extremely preterm and very low birth weight neonates have the highest rates of perioperative AKI.

  • Renal, hematologic, and respiratory comorbidities increase mortality risk in neonates with perioperative AKI.

Authors' Contributions

T.H.M. conceptualized and designed the study, analyzed the data, drafted the initial manuscript, and revised and edited the manuscript. C.M. designed the study, collected and analyzed the data, and revised and edited the manuscript. O.N. designed the study, analyzed the data, and revised and edited the manuscript. All authors contributed substantially and approved the manuscript in its final version.

Publication History

Received: 16 May 2023

Accepted: 25 August 2023

Accepted Manuscript online:
29 August 2023

Article published online:
25 September 2023

© 2023. Thieme. All rights reserved.

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