Acute Kidney Injury and Abnormalities on Brain Magnetic Resonance Imaging or Death in Infants with Hypoxic–Ischemic Encephalopathy: A Case–Control Study

Abstract

Objective This study aimed to analyze the association between acute kidney injury (AKI) and abnormalities on brain magnetic resonance imaging (MRI) or death in neonates treated with therapeutic hypothermia for hypoxic-ischemic encephalopathy (HIE).

Study Design This is a retrospective case–control analysis of 380 neonates born at ≥35 weeks' gestation treated with therapeutic hypothermia for HIE. Death or abnormal brain MRI using the basal ganglia watershed scoring system was compared between neonates with and without AKI.

Results A total of 51 (13.4%) neonates had AKI. Infants with AKI had higher rates of the composite of death or abnormal brain MRI (74.5 vs. 38.3%; p < 0.001). Rate of death (21.6 vs. 5.5%; p < 0.001) and severe abnormalities on MRI or death (43.1 vs. 19.1%; p < 0.001) were also higher in neonates with AKI.

Conclusion AKI is strongly associated with abnormalities on brain MRI or death in neonates with HIE. Identification of AKI in this patient population may be helpful in guiding clinical management and predicting potential neurodevelopmental impairment.

Key Points

• Neonates with HIE are at increased risk for AKI.

• AKI is associated with hypoxic-ischemic injury on brain MRI or death among neonates with HIE.

• Identification of AKI in infants with HIE may help predict neurodevelopmental impairment.

Keywords

acute kidney injury - hypoxic-ischemic encephalopathy - neonate - hypothermia

Author's Contributions

E.D. contributed to conceptualization, data collection, interpreted results, and drafted and revised the manuscript. K.T. was responsible for conceptualization and interpretation of MRI results and manuscript review. M.D. conceptualized, collected, and analyzed data, interpreted results, and reviewed the manuscript. D.C., K.S., D.M., and S.A.J. interpreted results and critically reviewed the manuscript. Z.H.A. conceptualized and designed the study, performed data analysis, interpreted results, and critically reviewed the manuscript. All authors approved the final manuscript submitted.

Publication History

Received: 22 February 2023

Accepted: 28 June 2023

Article published online:
04 August 2023

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