Affiliation:
1. Department of Paediatrics and Child Health, School of Medicine, University of Zambia, Lusaka, Zambia
2. Department of Paediatrics, University Teaching Hospitals-Children’s Hospital, Lusaka, Zambia
3. Department of Neonatology, University Teaching Hospitals-Women and New-born Hospital, Lusaka, Zambia
Abstract
Background: Neonatal acute kidney injury (nAKI) has been reported to be common among neonates admitted to the Neonatal Intensive Care Unit (NICU) and is associated with increased mortality and prolonged duration of hospital stay. However, data on this entity from sub-Saharan Africa are scanty. Objectives: This study aimed to assess the burden, risk factors, and short-term outcomes of nAKI in neonates admitted to a low-resource NICU in Zambia. Design: The design of the study is a prospective cohort study. Setting: The setting of this study was the NICU at the Women and Newborn Hospital of the University Teaching Hospitals (WNBH-UTHs). Patients: In total, 322 neonates who were admitted to the NICU between November 2021 and December 2022. Methods: A serum creatinine was determined on all patients at admission (within 24 hours), at 72 hours and day 7. The modified neonatal Kidney Disease: Improving Global Outcome (KDIGO) Criteria were used to define nAKI. Data were extracted using a predesigned form and analyzed using SPSS. A P-value less than .05 was considered statistically significant. Results: The prevalence of nAKI was 13.7% (44/322). On multivariable regression analysis, antepartum hemorrhage (adjusted odds ratio [AOR] 5.58; 95% confidence interval [CI]: [1.62-19.13], P = .007), vomiting in the neonate (AOR 5.76; 95% CI: [1.10-30.32], P = .04), history of use of unit second-line antibiotics, meropenem (AOR 4.37; 95% CI: [1.97-9.69], P < .001), and ciprofloxacin (AOR 4.53; 95% CI: [1.22-16.84], P = .02) were associated with increased risk of nAKI. Acute kidney injury (AKI) was significantly associated with longer length of hospital stay and higher mortality ( P < .05). Limitations: The study did not use the urine output criteria to define nAKI and this may have led to an underestimation of nAKI prevalence. Additionally, kidney, ureter, and bladder ultrasound was not performed on any of the study participants. Conclusion: AKI is common in neonates admitted to the NICU at WNBH-UTHs, and it is associated with a higher risk of mortality and prolonged length of hospital stay. Further studies among the various NICU sub-populations are needed to better characterize risks and outcomes.