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The impact of increased awareness of acute kidney injury in the Neonatal Intensive Care Unit on acute kidney injury incidence and reporting: results of a retrospective cohort study

Journal of Perinatology volume 40, pages 1301–1307 (2020)Cite this article

Subjects

Abstract

Objective

To evaluate the impact of nephrology integration in the NICU on acute kidney injury (AKI) incidence, provider reporting, and nephrology referral.

Study design

Cohort study in a single-center NICU from January 2012 to December 2017 (n = 1464). We assessed the impact of clinical practice changes including neonatal-nephrology rounds on the incidence of AKI.

Results

AKI occurred in 318 neonates (22%). AKI occurred less frequently in those admitted after clinical practice changes (P < 0.001). After multivariable adjustment, clinical practice changes were associated with reduced odds of AKI (adjusted odds ratio, 0.31; 95% CI 0.22–0.44, P < 0.001). Provider reporting of AKI improved (P < 0.001) and more neonates were referred for nephrology follow-up (P < 0.001).

Conclusions

Increased nephrology integration in the NICU was associated with decreased AKI incidence. While recognition of AKI improved, AKI remained poorly reported and nephrology AKI follow-up did not routinely occur. This study supports the importance of increased nephrology involvement in the NICU.

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Fig. 1: Clinical Practice Changes Instituted in 2015.
Fig. 2

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Data availability

Data is available upon request.

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Funding

This study was supported in part by NIH T32DK007662 (MS, AK). The authors declare that they have no other relevant financial interests.

Author information

Authors and Affiliations

  1. Division of Nephrology, Department of Pediatrics, Indiana University, Indianapolis, IN, USA

    Michelle C. Starr

  2. Division of Nephrology, Department of Pediatrics, Seattle Children’s Hospital and University of Washington, Seattle, WA, USA

    Michelle C. Starr, Alexander Kula, Shina Menon & Sangeeta Hingorani

  3. Department of Laboratory Medicine, University of Washington, Seattle, WA, USA

    Joshua Lieberman

  4. Department of Biostatistics, Indiana University, Indianapolis, IN, USA

    Anthony J. Perkins

  5. Division of Neonatology, Department of Pediatrics, Seattle Children’s Hospital and University of Washington, Seattle, WA, USA

    Teresa Lam & Shilpi Chabra

Authors
  1. Michelle C. Starr
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  2. Alexander Kula
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  4. Shina Menon
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  6. Teresa Lam
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  8. Sangeeta Hingorani
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Contributions

MS and AK conceptualized and designed the study, collected data, carried out the initial analysis, drafted the initial manuscript, and reviewed and revised the manuscript. JL and TL conceptualized and designed the study and reviewed and revised the manuscript. SM assisted with data analysis, and reviewed and revised the manuscript. AP carried out the analysis, and reviewed and revised the manuscript. SC and SH supervised the conceptualization and design of the study and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Michelle C. Starr.

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Conflict of interest

The authors declare that they have no conflict of interest.

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The Institutional Review Boards at the University of Washington and Seattle Children’s Hospital approved the study protocol.

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Starr, M.C., Kula, A., Lieberman, J. et al. The impact of increased awareness of acute kidney injury in the Neonatal Intensive Care Unit on acute kidney injury incidence and reporting: results of a retrospective cohort study. J Perinatol 40, 1301–1307 (2020). https://doi.org/10.1038/s41372-020-0725-y

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  • DOI: https://doi.org/10.1038/s41372-020-0725-y

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