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Approaches to neonatal acute kidney injury consultation and follow-up: results of a provider survey

Journal of Perinatology (2024)Cite this article

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Acute kidney injury (AKI) is common in those admitted to the Neonatal Intensive Care Unit (NICU) [1]. Neonates with AKI include multiple high-risk groups, including premature neonates, term infants with critical illness, and infants with critical cardiac disease [1]. Neonates with AKI may have a higher risk of poor long-term kidney outcomes [2]. For example, preterm neonates have a fourfold increase for chronic kidney disease and twofold increase for hypertension [3]. Yet no standard exists for inpatient care or outpatient follow-up of kidney outcomes and little is known about approaches following discharge [1]. We aimed to understand current approaches to neonatal AKI inpatient care and outpatient follow-up.

A group of pediatric nephrologists and neonatologists created a survey to evaluate practices in neonatal AKI inpatient care and outpatient follow-up. We distributed this electronic survey between September and December 2023 to all members of the Neonatal Kidney Collaborative (N = 343) and by social media to target providers who care for neonates with or at risk for AKI during their hospitalization. Questions included unit characteristics, inpatient neonatal AKI practices, and outpatient follow-up (Supplemental Item 1). As a sub-analysis, we evaluated AKI practices among the Top 50 Children’s Hospitals using publicly available US News and World Reports (USNWR) listing. For this analysis, results were analyzed by center, not respondents.

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Fig. 1: Provider reported follow-up practices and laboratory assessment for infants with neonatal AKI.

Data availability

Data is available for sharing upon reasonable request dependent on IRB approval and data sharing agreements between institutions.

References

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Acknowledgements

The authors would like to thank Samantha Wallace and Anna Latimer (Department of Pediatrics, Indiana University School of Medicine) for help with survey design, technical editing, and proofreading of this manuscript. We would like to thank all who participated in this survey.

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Authors and Affiliations

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

    Alex Feeney & Michelle C. Starr

  2. Division of Neonatology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    Cara L. Slagle

  3. Division of Neonatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WA, USA

    Matthew W. Harer

  4. Division of Nephrology, Department of Pediatrics, UVA Childrens and University of Virginia School of Medicine, Charlottesville, VA, USA

    Jennifer R. Charlton

  5. Division of Nephrology and Hypertension, Nationwide Children’s Hospital and The Ohio State University School of Medicine, Columbus, OH, USA

    Tahagod Mohamed

  6. Division of Nephrology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA

    David J. Askenazi

  7. Division of Nephrology, Department of Pediatrics, Stanford University, Palo Alto, CA, USA

    Shina Menon

  8. Division of Nephrology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA

    David T. Selewski

  9. Division of Child Health Service Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA

    Michelle C. Starr

Authors
  1. Alex Feeney
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  2. Cara L. Slagle
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  3. Matthew W. Harer
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  4. Jennifer R. Charlton
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  5. Tahagod Mohamed
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  6. David J. Askenazi
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  7. Shina Menon
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  8. David T. Selewski
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  9. Michelle C. Starr
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Contributions

AF, MCS: significant contributions to the design and conception, data analysis and interpretation, drafting the manuscript, critical revision of the manuscript, and final approval. DA, DS: contributions to the design and conception, data analysis, interpretation, and critical revision of the manuscript. CS, MWH, JRC, TM, SM: contributions to design and revision of the manuscript.

Corresponding author

Correspondence to Michelle C. Starr.

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Competing interests

All authors report no real or perceived conflicts of interest that could affect the study design, collection, analysis, and interpretation of data, the writing of the report, or the decision to submit the manuscript for publication. For full disclosure, we provide the additional list of authors’ other funding not directly related to this study. DA is a consultant for Baxter, Nuwellis, Medtronic Bioporto, and Seastar. His institution receives grant funding for education and research that is not related to this project from NIH, Baxter, Nuwellis, Medtronic, Bioporto, and Seastar. He has patents pending on inventions to improve the kidney care of neonates. He is the Founder and Chief Scientific Officer for Zorro-Flow. MS is supported in part by the Indiana University School of Medicine Physician Scientist Initiative and the NIH/NHLBI and NIH/NIDDK. JRC is supported by the NIH/NIDDK, consultant for Medtronics. CS MWH JRC DJA SM DS and MCS are board members of the Neonatal Kidney Collaborative. The authors have no financial disclosures. The funding sources for this study had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Consent for publication

Patient consent was not required for this study, IRB approved at Indiana University School of Medicine.

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Feeney, A., Slagle, C.L., Harer, M.W. et al. Approaches to neonatal acute kidney injury consultation and follow-up: results of a provider survey. J Perinatol (2024). https://doi.org/10.1038/s41372-024-02016-z

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  • DOI: https://doi.org/10.1038/s41372-024-02016-z

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