Associated factors for acute kidney injury in preterm infants

a cross-sectional study based on records data of preterm newborns hospitalized in two neonatal units in northwest Paraná State in 2015. For data analysis, the logistic regression model was used by the stepwise forward method and Fisher’s Exact Test.

Results:

132 preterm newborns, with a prevalence of 7.5% of acute kidney injury, were hospitalized. Majority of males, extremely preterm and very low birth weight. Associated factors were the use of non-nephrotoxic antibiotics and the presence of mechanical pulmonary ventilation, increasing the chance of developing acute kidney damage by 2.98 and 1.33/day, respectively. Hospitalization days constituted a protection factor.

Conclusion:

this study was able to identify the prevalence, and outline the variables associated with acute kidney injury in preterm newborns in a particular care situation.

Descriptors:
Acute Kidney Injury; Infant; Premature; Intensive Care Units; Neonatal; Newborn; Child Health Services

	AKI		Without AKI		Total
	n	%	n	%	n	%
Gender
Female	3	30.0	52	42.6	55	41.7
Male	7	70.0	70	57.4	77	58.3
Gestational age
Moderate/late preterm	3	30.0	77	63.1	80	60.6
Very preterm	1	10.0	28	23.0	29	22.0
Extreme preterm	6	60.0	12	9.8	18	13.6
Gestational age not numerically described^* * Gestational age was not numerically described, but it was recorded that the newborns was preterm newborns.	-	-	5	4.1	5	3.8
Weight at birth
<1,500	6	60.0	33	27.0	39	29.5
1,500 to <2,500	3	30.0	68	55.7	71	53.8
≥2,500	1	10.0	19	15.6	20	15.2
Ignored	-	-	2	1.6	2	1.6
Apgar at the fifth minute
≥7	8	80.0	113	85.6	121	91.6
<7	2	20.0	7	5.3	9	6.8
Ignored	-	-	2	1.5	2	1.5

Variables	Mean	Median	Variation	CV%	Minimum	Maximum
PTNB with AKI
Maternal age	21.7	19.50	34.79	24.12	17.00	32.00
Prenatal consultation number	4.67	4.0	9.33	65.47	2.00	8.00
Gestational age	29.3	27.8	27.5	17.9	22.4	36.4
Birth weight	1394.5	1135	684363.6	89.8	530.0	2915.0
MPV^* * MPV - Mechanical Pulmonary Ventilation;	18.4	11	272.9	89.8	0.0	47.0
Umbilical cateter	2.8	2	11.2	120.5	0.0	9.0
PICC^ PICC- Peripherally Inserted Central Catheter,	20.8	18	223.6	72.1	0.0	45.0
GCA^* ***** GCA- Gestationally Corrected Age.	35.7	38	31.7	15.7	25.1	39.7
Discharge weight	2288.1	2485	574453.8	33.1	756.0	3086.0
Days of hospitalization	47.6	27	1958.5	93.0	2.0	122.0
Nephrotoxic antibiotic	1.6	1	1.2	67.2	0.0	3.0
Non-nephrotoxic antibiotic	3.3	3	5.6	71.5	1.0	8.0
PTNB without AKI
Maternal age	25.63	26.00	44.76	26.10	14.00	38.00
Prenatal consultation number	6.91	7.00	7.14	38.64	3.00	13.00
Gestational age	32.2	33.0	10.5	10.1	24.0	36.0
Birth weight	1846.8	1867.0	396533.6	34.1	440.0	3020.0
MPV^* * MPV - Mechanical Pulmonary Ventilation;	4.2	1.0	79.9	212.5	0.0	59.0
Umbilical cateter	1.7	0.0	5.7	141.0	0.0	8.0
PICC^ PICC- Peripherally Inserted Central Catheter,	8.6	7.0	94.2	112.8	0.0	49.0
GCA^* ***** GCA- Gestationally Corrected Age.	34.3	36.4	69.6	24.3	0.4	39.7
Discharge weight	2086.6	254.5	3409.6	24.1	440.0	4230.0
Days of hospitalization	26.4	20.5	511.8	85.7	1.0	112.0
Nephrotoxic antibiotic	0.9	1.0	0.8	102.8	0.0	4.0
Non-nephrotoxic antibiotic	1.2	1.0	1.8	110.4	0.0	6.0

Standards	Estimate	Standard Error	Statistics test	p value
Gestational age	-0.0296	0.0122	5.87	0.0154^* * p value <0.05.
Birth weight	-0.0011	0.0005	4.15	0.0416^* * p value <0.05.
MPV^ MPV- Mechanical Pulmonary Ventilation/	0.0693	0.0213	10.63	0.0011^* * p value <0.05.
Use of exygen	0.0513	0.0300	2.91	0.0879^* * p value <0.05.
PICC^* ***** PICC- Peripherally Inserted Central Catheter.	0.0777	0.0282	7.56	0.0060*
Days of hospitalization	0.0239	0.0101	5.58	0.0182*
Nephrotoxic antibiotic	0.7257	0.3122	5.40	0.0201*
Non-nephrotoxic antibiotic	0.6484	0.1896	11.70	0.0006*
Maternal age	-0.0995	0.0649	2.35	0.1254^† † p value <0.25.
Umbilical cateter	0.1538	0.1251	1.51	0.2191^† † p value <0.25.

	adjOR^* * Model adjusted by hospital of origin.	p value	95%CI
	adjOR^* * Model adjusted by hospital of origin.	p value	Lower limit of 95% CI	Upper limit of 95% CI
Mechanical Pulmonary Ventilation	1.33		1.0787	1.6317
Days of hospitalization	0.89		0.8186	0.9754
Non-nephrotoxic antibiotics	2.98		1.2901	6.9005

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[1] Corresponding Author: Larissa Carolina Segantini Felipin. E-mail: larissafelipin@gmail.com