Acute Kidney Injury is Associated with Subsequent infection in Neonates After the Norwood Procedure: a Retrospective Chart Review

Overview

Journal Pediatr Nephrol

Specialties Nephrology
Pediatrics

Date 2018 Mar 7

PMID 29508077

Citations 13

Authors

Megan SooHoo

Benjamin Griffin

Anna Jovanovich

Danielle E Soranno

Emily Mack

Sonali S Patel

Sarah Faubel

Katja M Gist

Affiliations

Soon will be listed here.

Abstract

Background: Acute kidney injury (AKI) and infection are common complications after pediatric cardiac surgery. No pediatric study has evaluated for an association between postoperative AKI and infection. The objective of this study was to determine if AKI in neonates after cardiopulmonary bypass was associated with the development of a postoperative infection.

Methods: We performed a single center retrospective chart review from January 2009 to December 2015 of neonates (age ≤ 30 days) undergoing the Norwood procedure. AKI was defined by the modified neonatal Kidney Disease Improving Global outcomes serum creatinine criteria using (1) measured serum creatinine and (2) creatinine corrected for fluid balance on postoperative days 1-4. Infection, (culture positive or presumed), must have occurred after a diagnosis of AKI and within 60 days of surgery.

Results: Ninety-five patients were included, of which postoperative infection occurred in 42 (44%). AKI occurred in 38 (40%) and 42 (44%) patients by measured serum creatinine and fluid overload corrected creatinine, respectively, and was most commonly diagnosed on postoperative day 2. The median time to infection from the time of surgery and AKI was 7 days (IQR 5-14 days) and 6 days (IQR 3-13 days), respectively. After adjusting for confounders, the odds of a postoperative infection were 3.64 times greater in patients with fluid corrected AKI (95% CI, 1.36-9.75; p = 0.01).

Conclusions: Fluid corrected AKI was independently associated with the development of a postoperative infection. These findings support the notion that AKI is an immunosuppressed state that increases the risk of infection.

Citing Articles

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C-C motif chemokine ligand 14 characterization for prediction of persistent severe AKI in post-cardiac surgery children.

Brandewie K, Alten J, Goldstein S, Rose J, Kim M, Ollberding N Pediatr Nephrol. 2024; 40(4):1103-1109.

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Fluid Overload and AKI After the Norwood Operation: The Correlation and Characterization of Routine Clinical Markers.

Weld J, Kim E, Chandra P, Savorgnan F, Acosta S, Flores S Pediatr Cardiol. 2023; 45(7):1440-1447.

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Early prediction of acute kidney injury in neonates with cardiac surgery.

Shi S, Fan J, Shu Q World J Pediatr Surg. 2022; 3(2):e000107.

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The Neglected Price of Pediatric Acute Kidney Injury: Non-renal Implications.

Pande C, Smith M, Soranno D, Gist K, Fuhrman D, Dolan K Front Pediatr. 2022; 10:893993.

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