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Acute kidney injury in infants diagnosed with congenital diaphragmatic hernia

Pediatric Research (2023)Cite this article

Abstract

Background

To assess the association and outcomes of acute kidney injury (AKI) in infants diagnosed with congenital diaphragmatic hernia (CDH).

Methods

We analyzed the National Inpatient Sample dataset for the years 2010 through 2018. We evaluated the prevalence and outcomes associated with AKI in infants diagnosed with CDH. Outcomes were assessed using regression analysis while controlling for variables.

Results

A total of 32,042,481 term infants were identified, of them 10,804 had CDH. Prevalence of AKI in infants with CDH was 6.5% compared to 0.05% in those without CDH (aOR = 14.7, CI: 13.0–16.6). ECMO was utilized at 62% of CDH infants that had AKI compared to 17% in infants without AKI (aOR = 4.22, CI: 3.38–5.27). Mortality was greater in CDH infants who developed AKI when compared to those without AKI (57.3 vs. 16.7%, aOR = 3.65, CI: 2.99–4.46). The trend of mortality in CDH infants who developed AKI decreased overtime, p < 0.001, while the trends for mortality in the overall CDH infants and in CDH infants without AKI did not change during the study period, p = 0.12.

Conclusion

AKI is not uncommon in infants diagnosed with CDH. ECMO utilization and mortality are substantially increased in CDH infants when they develop AKI.

Impact

  • Mortality in infants diagnosed with congenital diaphragmatic hernia (CDH) is relatively high despite advances in neonatal care.

  • Infants with CDH are potentially at increased risk of acute kidney injury (AKI).

  • Within CDH population, infants diagnosed with AKI are at increased risk for ECMO use and mortality.

  • This is the largest study to address the association and outcomes of AKI in term infants diagnosed with CDH.

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Fig. 1: Flow diagram of the study population.
Fig. 2: Mortality among infants with congenital diaphragmatic hernia in the overall sample and in infants with and without acute kidney injury (AKI).

Data availability

All data generated or analyzed during this study are included in this article.

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Author notes

  1. These authors contributed equally: Mohamed A. Mohamed, Hany Aly.

Authors and Affiliations

  1. Department of Neonatology, Cleveland Clinic Children’s, Cleveland, Ohio & Department of Pediatrics, University of Florida, Jacksonville, FL, USA

    Marwa M. Elgendy

  2. Department of Neonatology, Cleveland Clinic Children’s, Cleveland, OH, USA

    Afeez Adisa, Mohsen Farghaly, Mohamed A. Mohamed & Hany Aly

  3. Department of Pediatrics, MetroHealth Medical center, Cleveland, OH, USA

    Mahmoud Ali

Authors
  1. Marwa M. Elgendy
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  2. Afeez Adisa
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  3. Mohsen Farghaly
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  4. Mahmoud Ali
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  5. Mohamed A. Mohamed
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Contributions

M.M.E., M.A.M., and H.A. participated in the conception and the design of the work including, the acquisition, analysis, and interpretation of the statistical analyses, drafting the initial manuscript, reviewing, and revision of the manuscript. They coordinated, and supervised data collection, and critically reviewed the manuscript for important intellectual content. A.A., M.F., and M.A. conceptualized and designed the study, carried out the initial analyses, drafted the work 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 in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Dr. Mohamed A. Mohamed and Dr. Hany Aly have Joint senior authorship.

Corresponding author

Correspondence to Marwa M. Elgendy.

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Elgendy, M.M., Adisa, A., Farghaly, M. et al. Acute kidney injury in infants diagnosed with congenital diaphragmatic hernia. Pediatr Res (2023). https://doi.org/10.1038/s41390-023-02545-x

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