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  • Epidemiology of Neonatal Ac...
    Sasaki, Jun; Rodriguez, Zahidee; Alten, Jeffrey A.; Rahman, AKM Fazlur; Reichle, Garrett; Lin, Paul; Banerjee, Mousumi; Selewski, David; Gaies, Michael; Hock, Kristal M.; Borasino, Santiago; Gist, Katja M.; Prodhan, Parthak; Garcia, Xiomara; Ramer, Shannon; Sherman, Mindy; Ghbeis, Muhammad B.; Clarke, Shanelle A.; Lukacs, Mary; Zanaboni, Dominic; Sanchez de Toledo, Joan; Domnina, Yuliya A.; Saenz, Lucas; Baust, Tracy; Kluck, Jane; Duncan, Linda; Koch, Joshua D.; Diddle, J. Wesley; Freytag, Joshua; Harris, Amanda; Abraha, Hideat; Butcher, John; Tadphale, Sachin D.; Krawczeski, Catherine D.; Kwiatkowski, David M.; Raymond, Tia T.; Burton, Grant L.; Das, Ashima; Shan, Tajas; Buckley, Jason R.; Schroeder, Luke; Raees, Aanish; Guidry, Bradley; Sosa, Lisa J.; Bailly, David K.; Valentine, Kevin M.; Bhat, Priya N.; Neumayr, Tara M.; Afonso, Natasha S.; O’Neal, Erika R.; Lasa, Javier J.; Huskey, Jordan L.; Phillips, Patrick A.; Ardisana, Amy; Gonzalez, Kim; Columb, Eric; Domar, Tammy; Viers, Suzanne

    The Annals of thoracic surgery, 11/2022, Letnik: 114, Številka: 5
    Journal Article

    The purpose of this Neonatal and Pediatric Heart and Renal Outcomes Network study was to describe the epidemiology and outcomes of cardiac surgery–associated acute kidney injury (CS-AKI) after cardiac surgery without cardiopulmonary bypass (non-CPB). We performed a retrospective study of neonates (≤30 days) who underwent non-CPB cardiac surgery at 22 centers affiliated with the Pediatric Cardiac Critical Care Consortium. CS-AKI was defined using the modified Kidney Disease: Improving Global Outcomes serum creatinine and urine output criteria from postoperative days 0 to 6. CS-AKI defined by serum creatinine was further subclassified into transient (resolved by postoperative day 3) and persistent/late (≥3 days). Multivariable regression analyses were used to determine risk factors for CS-AKI and associations with outcomes of ventilation hours and cardiac intensive care unit length of stay. Five hundred eighty-two neonates (median age at surgery, 9 days interquartile range, 5-15, 25% functional single ventricle were included. CS-AKI occurred in 38.3%: Rate and severity varied across centers. Aggregate daily CS-AKI prevalence peaked on postoperative day 1 (17.1%). No stage of CS-AKI was associated with ventilation hours or length of stay. Persistent/late CS-AKI occurred in 48 patients (8%). Prostaglandin use and single-ventricle surgery were associated with persistent/late CS-AKI. Higher baseline serum creatinine but not persistent/late CS-AKI was associated with longer ventilation duration and intensive care unit length of stay after adjusting for confounders. Kidney Disease: Improving Global Outcomes–defined CS-AKI occurred commonly in neonates undergoing non-CPB cardiac surgery. However most CS-AKI was transient, and no CS-AKI classification was associated with worse outcomes. Further work is needed to determine the CS-AKI definition that best associates with outcomes in this cohort.