Acute Kidney Injury and Bronchopulmonary Dysplasia in Premature Neonates Born Less than 32 Weeks' GestationFunding Cincinnati Children's Hospital Center for Acute Care Nephrology provided funding to create and maintain the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) study Medidata Rave electronic database. The Pediatric and Infant Center for Acute Nephrology (PICAN) provided support for web meetings and for the Neonatal Kidney Collaborative (NKC) steering committee annual meeting at The University of Alabama at Birmingham (UAB), as well as support for two of the AWAKEN study investigators at UAB (D.A., R.G., and L.B.). PICAN is part of the Department of Pediatrics at UAB and is funded by Children's of Alabama hospital, UAB Department of Pediatrics, UAB School of Medicine, and UAB Center for Clinical and Translational Sciences (National Institutes of Health grant UL1TR001417). Finally, the AWAKEN study at The University of New Mexico was supported by the Clinical and Translational Science Center at The University of New Mexico (National Institutes of Health grant UL1TR001449) and by The University of Iowa Institute for Clinical and Translational Science (grant U54TR001356). The AWAKEN study investigators at the Canberra Hospital at the Australian National University Medical School were supported by the Canberra Hospital Private Practice Fund, and investigators at University of Virginia Children's Hospital were supported by a 100 Women Who Care Grant from the 100 Women Charitable Foundation. The funding sources for this study had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
02 May 2019
07 October 2019
27 November 2019 (online)
Objective This study aimed to evaluate the association between acute kidney injury (AKI) and bronchopulmonary dysplasia (BPD) in infants born <32 weeks of gestational age (GA).
Study Design Present study is a secondary analysis of premature infants born at <32 weeks of GA in the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) retrospective cohort (n = 546). We stratified by gestational age and used logistic regression to determine association between AKI and moderate or severe BPD/mortality.
Results Moderate or severe BPD occurred in 214 of 546 (39%) infants, while death occurred in 32 of 546 (6%); the composite of moderate or severe BPD/death occurred in 246 of 546 (45%). For infants born ≤29 weeks of gestation, the adjusted odds ratio (OR) of AKI and the primary outcome was 1.15 (95% confidence interval [CI] = 0.47–2.86; p = 0.76). Infants born between 29 and 32 weeks of gestation with AKI had four-fold higher odds of moderate or severe BPD/death that remained after controlling for multiple factors (adjusted OR = 4.21, 95% CI: 2.07–8.61; p < 0.001).
Conclusion Neonates born between 29 and 32 weeks who develop AKI had a higher likelihood of moderate or severe BPD/death than those without AKI. Further studies are needed to validate our findings and evaluate mechanisms of multiorgan injury.
Keywordsacute renal failure - acute lung injury - bronchopulmonary dysplasia - chronic lung disease - organ crosstalk - prematurity - neonate
Neonatal Kidney Collaborative Contributors
Namasivayam Ambalavanan, MD—Children's of Alabama, University of Alabama at Birmingham, Birmingham, AL.
David T. Selewski, MD, Medical University of South Carolina, Charlston, SC. Subrata Sarkar, MD—C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI.
Jeffery Fletcher, PhD—Centenary Hospital for Women and Children, Canberra Hospital, Australian National University Medical School, Canberra, Australia.
Carolyn L. Abitbol, MD, Marissa DeFreitas, MD, Shahnaz Duara, MD—Holtz Children's Hospital, University of Miami, Miami, FL.
Alison Kent, MD, Jennifer R. Charlton, MD, Jonathan R. Swanson MD—University of Virginia Children's Hospital, Charlottesville, VA.
Ronnie Guillet, MD, Carl D'Angio, MD, Ayesa Mian, MD, Erin Rademacher, MD—Golisano Children's Hospital, University of Rochester, Rochester, NY.
Maroun J. Mhanna, MD, Rupesh Raina, MD, Deepak Kumar, MD—MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH.
Jennifer G. Jetton, MD, Patrick D. Brophy, MD, Tarah T. Colaizy, MD, Jonathan M. Klein, MD—University of Iowa Children's Hospital, Iowa City, IA.
Ayse Akcan Arikan, MD, Christopher J. Rhee, MD—Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
Stuart L. Goldstein, MD, Amy T. Nathan, MD—Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Juan C. Kupferman, MD, Alok Bhutada, MD, Shantanu Rastogi, MD—Maimonides Medical Center, Brooklyn, NY.
Elizabeth Bonachea, MD, John Mahan, MD—Nationwide Children's Hospital, Columbus, OH.
F. Sessions Cole, MD, T. Keefe Davis, MD—Washington University, St. Louis, MO.
Joshua Dower, MD, Lawrence Milner, MD, Alexandra Smith, MD—Tufts University School of Medicine, Boston, MA.
Mamta Fuloria, MD, Kimberly Reidy, MD, Frederick J. Kaskel, MD—The Children's Hospital at Montefiore, Bronx, NY.
Danielle E. Soranno, MD Jason Gien, MD, Katja M. Gist, DO—University of Colorado, Children's Hospital Colorado, Aurora, CO.
Aftab S. Chishti, MD, Mina H. Hanna, MD—University of Kentucky, Lexington, KY.
Craig S. Wong, MD, Catherine Joseph, MD, Tara DuPont, MD, Robin Ohls, MD, Amy Staples, MD—University of New Mexico Health Sciences Center, Albuquerque, NM.
Surender Khokhar, MD—Apollo Cradle, Gurgaon, Haryana, India.
Sofia Perazzo, MD, Patricio E. Ray, Mary Revenis, MD—Children's National Medical Center, George Washington University School of Medicine and the Health Sciences, Washington DC.
Sidharth K. Sethi, MD, Smriri Rohatgi, MD—Medanta, The Medicity, Gurgaon, India
Cherry Mammen, MD, Anne Synnes, MDCM—British Columbia Childrens Hospital, Vancouver, British Columbia, Canada.
Sanjay Wazir, MD—Cloudnine Hospital, Gurgaon, Haryana, India.
Pia Wintermark, MD—Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Robert Woroniecki, MD, Shanty Sridhar, MD—Stony Brook School of Medicine, Stony Brook, NY.
Susan Ingraham, MD—Kapi'olani Medical Center for Women and Children John A. Burns School of Medicine, University of Hawaii, HI.
Arwa Nada, MD–Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.
Michael Zappitelli, MD–Toronto Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Additional Contributions: The authors would also like to thank the outstanding work of the following clinical research personnel and colleagues for their involvement in AWAKEN:
Ariana Aimani, Samantha Kronish, Ana Palijan, MD, Michael Pizzi—Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Laila Ajour, BS, Julia Wrona, BS—University of Colorado, Children's Hospital Colorado, Aurora, CO; Melissa Bowman, RN—University of Rochester, Rochester, NY; Teresa Cano, RN, Marta G. Galarza, MD, Wendy Glaberson, MD, Aura Arenas Morales, MD, Denisse Cristina Pareja Valarezo, MD—Holtz Children's Hospital, University of Miami, Miami, FL; Sarah Cashman, BS, Madeleine Stead, BS—University of Iowa Children's Hospital, Iowa City, IA; Jonathan Davis, MD, Julie Nicoletta, MD—Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, MA; Alanna DeMello—British Columbia Children's Hospital, Vancouver, British Columbia, Canada; Lynn Dill, RN—University of Alabama at Birmingham, Birmingham, AL; Ellen Guthrie, RN—MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH; Nicholas L. Harris, BS, Susan M. Hieber, MSQM—C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI; Katherine Huang, Rosa Waters—University of Virginia Children's Hospital, Charlottesville, VA; Judd Jacobs, Ryan Knox, BS, Hilary Pitner, MS, Tara Terrell—Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Nilima Jawale, MD—Maimonides Medical Center, Brooklyn, NY; Emily Kane—Australian National University, Canberra, Australia; Vijay Kher, DM, Puneet Sodhi, MBBS—Medanta Kidney Institute, The Medicity Hospital, Gurgaon, Haryana, India; Grace Mele—New York College of Osteopathic Medicine, Westbury, NY; Patricia Mele, DNP—Stony Brook Children's Hospital, Stony Brook, NY; Charity Njoku, Tennille Paulsen, Sadia Zubair—Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Emily Pao—University of Washington, Seattle Children's Hospital, Seattle, WA; Becky Selman RN, Michele Spear, CCRC—University of New Mexico Health Sciences Center Albuquerque, NM; Melissa Vega, PA-C—The Children's Hospital at Montefiore, Bronx, NY; Leslie Walther RN—Washington University, St. Louis, MO.
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