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Am J Perinatol 2018; 35(01): 001-009
DOI: 10.1055/s-0037-1604260
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neonatal Acute Kidney Injury: A Survey of Neonatologists' and Nephrologists' Perceptions and Practice Management

A. L. Kent   *
1   Department of Neonatology, Canberra and Australian National University, Canberra, Australia
,
J. R. Charlton   *
2   Department of Pediatrics, University of Virginia, Charlottesville, Virginia
,
R. Guillet
3   Division of Neonatology, Department of Pediatrics, University of Rochester, Rochester, New York
,
K. M. Gist
4   Department of Pediatrics, University of Colorado, Aurora, Colorado
,
M. Hanna
5   Department of Pediatrics, University of Kentucky, Lexington, Kentucky
,
A. El Samra
6   Department of Pediatrics and Neonatology, Franciscan St. Elizabeth Health, East Lafayette, Indiana
,
J. Fletcher
7   Department of Paediatrics, Canberra and Australian National University, Canberra, Australia
,
D. T. Selewski
8   Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
,
C. Mammen
9   Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
› Institutsangaben
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Publikationsverlauf

17. April 2017

08. Juni 2017

Publikationsdatum:
14. Juli 2017 (online)

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Abstract

Background Neonatal acute kidney injury (AKI) occurs in 40 to 70% of critically ill neonatal intensive care admissions. This study explored the differences in perceptions and practice variations among neonatologists and pediatric nephrologists in diagnostic criteria, management, and follow-up of neonatal AKI.

Methods A survey weblink was emailed to nephrologists and neonatologists in Australia, Canada, New Zealand, India, and the United States. Questions consisted of demographic and unit practices, three clinical scenarios assessing awareness of definitions of neonatal AKI, knowledge, management, and follow-up practices.

Results Many knowledge gaps among neonatologists, and to a lesser extent, pediatric nephrologists were identified. Neonatologists were less likely to use categorical definitions of neonatal AKI (p < 0.00001) or diagnose stage 1 AKI (p < 0.00001) than pediatric nephrologists. Guidelines for creatinine monitoring for nephrotoxic medications were reported by 34% (aminoglycosides) and 62% (indomethacin) of respondents. Nephrologists were more likely to consider follow-up after AKI than neonatologists (p < 0.00001). Also, 92 and 86% of neonatologists and nephrologists, respectively, reported no standardization or infrastructure for long-term renal follow-up.

Conclusion Neonatal AKI is underappreciated, particularly among neonatologists. A lack of evidence on neonatal AKI contributes to this variation in response. Therefore, dissemination of current knowledge and areas for research should be the priority.

Keywords

neonatologist - pediatric nephrologist - neonatal acute kidney injury - survey

Authors' Contributions

Kent-contributed to the design of the project, analyzed data, wrote first draft of the manuscript, and critically reviewed/edited and approved the final version.


Charlton-contributed to the design of the project, contributed to the first draft of the manuscript, and critically reviewed/edited and approved the final version.


Guillet-contributed to the design of the project and critically reviewed/edited and approved the final version.


Gist-contributed to the design of the project and critically reviewed/edited and approved the final version.


Hanna-contributed to the design of the project and critically reviewed/edited and approved the final version.


El Samra-critically reviewed/edited and approved the final version.


Fletcher-critically reviewed/edited and approved the final version.


Selewski-contributed to the design of the project, contributed to early drafts of manuscript, and critically reviewed/edited and approved the final version.


Mammen-conceived the original idea, contributed to the design of the project, contributed to early drafts of manuscript, and critically reviewed/edited and approved the final version.


* Both the authors contributed equally to the article.


Supplementary Material