Abstract
Background
Daily serum creatinine monitoring protocols for acute kidney injury (AKI) are invasive and may lead to surveillance resistance. We aimed to understand if use of urine neutrophil gelatinase-associated lipocalin (uNGAL) could increase high-risk nephrotoxic medication (NTMx) associated AKI screening adherence in neonates.
Methods
Statistical process control methods prior to and post implementation were trended. The primary outcome, screening adherence, was defined as either daily serum creatinine or uNGAL assessment through 2 days post high-risk NTMx exposure.
Results
1291 monitoring days from the pre-implementation era (4/2020-6/2021) were compared to1377 monitoring days from the post-era (6/2021-10/2022). AKI screening adherence increased (81 to 92%) following implementation of optional uNGAL screening. Urine NGAL accounted for 35% of screening obtained. Use of uNGAL resulted in a 40% reduction in blood sampling for serum creatinine.
Conclusions
Incorporation of uNGAL as a complementary screening tool to serum creatinine demonstrated sustained increased AKI surveillance in our Baby NINJA monitoring program.
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Data availability
The datasets generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
Previous presentations from various information included in this manuscript include an oral abstract presented at the American Society of Nephrology Kidney Week, on November 3rd, 2022, in Orlando, FL as well as a poster presentation at the AKI & CRRT conference, in San Diego, CA, and Pediatric Academic Societies Conference, Washington D.C, 2023.
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CL Slagle was involved in conceptualization, methodology, data curation and analysis, and the writing of the original draft. TH was involved in conceptualization, methodology, data curation and analysis, and review of the original draft. HWG was involved in the conceptualization, methodology, data curation, and review of the original draft. KAK was involved in the conceptualization, methodology, data curation, and review of the original draft. SLG was involved in the conceptualization, methodology, and review of the original draft.
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Cara Slagle, MD is a consultant for AM Pharma and Medtronic and has received honorariums from Medtronic, the University of Alabama, and the AKI Critical Care Foundation, all unrelated to the work above. Stuart Goldstein, MD and Cincinnati Children’s Hospital receive royalties from Vigilanz Corporation (Minneapolis, MN) for the NINJA application licensed to Vigilanz from Cincinnati Children’s Hospital Medical Center. Dr. Goldstein consults and receives research funding from BioPorto Diagnostics, Inc, which markets The ProNephroAKI NGAL Test™.
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Slagle, C.L., Hemmelgarn, T., Gavigan, H.W. et al. Use of urine neutrophil gelatinase-associated lipocalin for nephrotoxic medication acute kidney injury screening in neonates. J Perinatol (2024). https://doi.org/10.1038/s41372-024-01922-6
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DOI: https://doi.org/10.1038/s41372-024-01922-6