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Am J Perinatol
DOI: 10.1055/a-2330-1244
Review Article

Necrotizing Enterocolitis-Associated Acute Kidney Injury—Transforming the Paradigm

Padma P. Garg
1   Department of Pediatrics Critical Care, University of Mississippi Medical Center, Jackson, Mississippi
,
Jeffrey Shenberger
2   Department of Pediatrics/Neonatology, Connecticut Children's, Hartford, Connecticut
,
Andrew M. South
3   Section of Nephrology, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
4   Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
,
Parvesh M. Garg
5   Department of Pediatrics/Neonatology, Wake Forest University, Winston-Salem, North Carolina
› Author Affiliations Funding A.M.S. has funding from the NHBLI K23-HL148394, R01-HL146818, L40-HL148910-2, and R01-HL164434. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Abstract

Necrotizing enterocolitis (NEC) is one of the most common conditions requiring emergency surgery in the neonatal intensive care unit and is associated with a septic shock-like state contributing to multiorgan dysfunction. NEC affects 6 to 10% of very low-birth-weight infants and remains a leading cause of death. The occurrence of severe acute kidney injury (AKI) following surgical NEC is a harbinger of multiple morbidities. This review presents current evidence about the clinical impact of NEC-associated AKI on the clinical outcomes. Studies evaluating nephroprotective strategies to prevent AKI and its consequences are greatly needed to improve the postoperative recovery and clinical outcomes in neonates with NEC. Future observational studies and clinical trials in preterm infants with NEC prioritize measuring short-term (AKI) and longer term (chronic kidney disease) kidney outcomes.

Key Points

  • Severe AKI is common following surgical NEC.

  • Severe AKI following NEC is associated with poor clinical outcomes.

  • Studies evaluating nephroprotective strategies to prevent AKI and its consequences are needed.

Impact

  1. Severe AKI (stage 2 and 3) occurs in 32.6% of neonates after NEC diagnosis and in 58.7% following surgical NEC diagnosis.

  2. NEC-associated AKI is associated with severe postoperative course, moderate-to-severe bronchopulmonary dysplasia, surgical complications, brain injury, and longer hospital stay in preterm infants.

  3. Severity of NEC-associated AKI can be utilized by bedside providers for the prognostication of clinical outcomes in preterm infants.

Keywords

preterm infant - NEC - AKI - outcomes

Authors' Contributions

P.M.G. conceptualized the idea. P.P.G., J.S., A.M.S., and P.M.G. wrote the article. All the authors approved the manuscript.




Publication History

Received: 04 April 2024

Accepted: 17 May 2024

Accepted Manuscript online:
20 May 2024

Article published online:
18 June 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

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