Necrotizing Enterocolitis-Associated Acute Kidney Injury—Transforming the Paradigm

Padma P. Garg; Jeffrey Shenberger; Andrew M. South; Parvesh M. Garg

doi:10.1055/a-2330-1244

American Journal of Perinatology, Table of Contents

Am J Perinatol 2025; 42(01): 108-112
DOI: 10.1055/a-2330-1244

Original Article

Necrotizing Enterocolitis-Associated Acute Kidney Injury—Transforming the Paradigm

Padma P. Garg

¹Department of Pediatrics Critical Care, University of Mississippi Medical Center, Jackson, Mississippi

,

Jeffrey Shenberger

²Department of Pediatrics/Neonatology, Connecticut Children's, Hartford, Connecticut

,

Andrew M. South

³Section of Nephrology, Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, North Carolina

⁴Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina

,

Parvesh M. Garg

⁵Department of Pediatrics/Neonatology, Wake Forest University, Winston-Salem, North Carolina

› Author Affiliations

Abstract

Necrotizing enterocolitis (NEC) is one of the most common conditions requiring emergency surgery in the neonatal intensive care unit and is associated with a septic shock-like state contributing to multiorgan dysfunction. NEC affects 6 to 10% of very low-birth-weight infants and remains a leading cause of death. The occurrence of severe acute kidney injury (AKI) following surgical NEC is a harbinger of multiple morbidities. This review presents current evidence about the clinical impact of NEC-associated AKI on the clinical outcomes. Studies evaluating nephroprotective strategies to prevent AKI and its consequences are greatly needed to improve the postoperative recovery and clinical outcomes in neonates with NEC. Future observational studies and clinical trials in preterm infants with NEC prioritize measuring short-term (AKI) and longer term (chronic kidney disease) kidney outcomes.

Key Points

Severe AKI is common following surgical NEC.
Severe AKI following NEC is associated with poor clinical outcomes.
Studies evaluating nephroprotective strategies to prevent AKI and its consequences are needed.

Impact

Severe AKI (stage 2 and 3) occurs in 32.6% of neonates after NEC diagnosis and in 58.7% following surgical NEC diagnosis.
NEC-associated AKI is associated with severe postoperative course, moderate-to-severe bronchopulmonary dysplasia, surgical complications, brain injury, and longer hospital stay in preterm infants.
Severity of NEC-associated AKI can be utilized by bedside providers for the prognostication of clinical outcomes in preterm infants.

Keywords

preterm infant - NEC - AKI - outcomes

Full Text

References

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