Acute Kidney Injury Guidelines Are Associated with Improved Recognition and Follow-up for Neonatal Patients

Katherine Vincent, Heidi J. Murphy, Julie R. Ross, Katherine E. Twombley, Pamela A. Harris-Haman, Ksenia Zukowsky

Research output: Contribution to journalArticle

Abstract

Background: Studies demonstrate that neonatal acute kidney injury (AKI) is associated with increased morbidity and mortality. Acute kidney injury survivors are at risk for renal dysfunction and chronic kidney disease and require long-term follow-up. Purpose: To maximize identification of AKI and ensure referral, we created guidelines for diagnosis, evaluation, and management of AKI. Methods/Search Strategy: Retrospective cohort study of neonatal intensive care unit patients treated before guideline implementation (cohort 1; n = 175) and after (cohort 2; n = 52). Outcome measures included AKI incidence, documented diagnosis, and pediatric nephrology consultation. Statistical methods included t tests, Fisher exact tests, and Wilcoxon rank sum tests. Findings/Results: We found 68 AKI episodes in 52 patients in cohort 1 and 15 episodes in 12 patients in cohort 2. Diagnosis and documentation of AKI improved after guideline implementation (C1:24/68 [35%], C2: 12/15 [80%]; P=.003) as did pediatric nephrology consultation (C1:12/68 [18%]; C2: 12/15 [80%]; P<.001) and outpatient referral (C1: 3/47 [6%], C2:5/8 [63%]; P<.01). Implications for Practice: Neonatal AKI guideline implementation was associated with improvements in recognition, diagnosis, and inpatient and outpatient nephrology consultation. Early recognition and diagnosis along with specialist referral may improve outcomes among neonatal AKI survivors, ensuring appropriate future monitoring and long-term follow-up. Implications for Research: Future research should continue to determine the long-term implications of early diagnosis of AKI and appropriate subspecialty care with follow-up.

Original languageEnglish (US)
JournalAdvances in Neonatal Care
DOIs
StateAccepted/In press - Jan 1 2019

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Acute Kidney Injury
Guidelines
Referral and Consultation
Nephrology
Nonparametric Statistics
Survivors
Early Diagnosis
Outpatients
Pediatrics
Aftercare
Neonatal Intensive Care Units
Chronic Renal Insufficiency
Documentation
Inpatients
Cohort Studies
Retrospective Studies
Outcome Assessment (Health Care)
Morbidity
Kidney
Mortality

Keywords

  • acute kidney injury
  • guidelines
  • neonatal
  • standardization of care, renal

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Acute Kidney Injury Guidelines Are Associated with Improved Recognition and Follow-up for Neonatal Patients. / Vincent, Katherine; Murphy, Heidi J.; Ross, Julie R.; Twombley, Katherine E.; Harris-Haman, Pamela A.; Zukowsky, Ksenia.

In: Advances in Neonatal Care, 01.01.2019.

Research output: Contribution to journalArticle

Vincent, Katherine ; Murphy, Heidi J. ; Ross, Julie R. ; Twombley, Katherine E. ; Harris-Haman, Pamela A. ; Zukowsky, Ksenia. / Acute Kidney Injury Guidelines Are Associated with Improved Recognition and Follow-up for Neonatal Patients. In: Advances in Neonatal Care. 2019.
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