Acute kidney injury among critically ill neonates in a tertiary hospital in Tanzania; Prevalence, risk factors and outcome

• Published in: PloS one 2020-02, Vol.15 (2), p.e0229074-e0229074
• Main Authors: Mwamanenge, Naomi A, Assenga, Evelyn, Furia, Francis F
• Format: Article
• Language: English
• Subjects: Acute Kidney Injury - blood; Acute Kidney Injury - diagnostic imaging; Acute Kidney Injury - epidemiology; Biology and Life Sciences; Birth weight; Bladder; Childrens health; Creatinine; Creatinine - blood; Critical Illness - epidemiology; Cross-Sectional Studies; Developing countries; Female; Gentamicin; Hospitals; Humans; Infant mortality; Infant, Newborn; Intensive Care Units - statistics & numerical data; Kidneys; LDCs; Logistic Models; Male; Medicine and Health Sciences; Mortality; Multivariate Analysis; Neonates; Newborn babies; Pneumonia; Prevalence; Regression analysis; Renal function; Risk analysis; Risk Factors; Sepsis; Tertiary Care Centers - statistics & numerical data; Ultrasonic imaging; Ultrasound
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0229074

Neonatal acute kidney injury contributes to high mortality in developing countries. The burden of neonatal AKI is not known in Tanzania despite having high neonatal mortality. This study was conducted to determine the burden of AKI among critically ill neonates admitted at Muhimbili National Hospital. This was a cross-sectional study conducted in the neonatal ward at the MNH. Eligible critically ill neonates were recruited consecutively between October 2017 and March 2018. Data was collected using a standardized structured questionnaire. Blood specimen was drawn to measure baseline creatinine at admission, 48th hour, 72nd hour and 14th day. Data was analysed using SPSS version 20.0 Univariate analysis was done using chi-square to determine the association between categorical variables and multivariate logistic regression was performed to determine predictors of AKI. A total of 378 critically ill neonates were recruited, 31.5% had AKI and independent predictors of AKI were noted to be neonatal sepsis (aOR 2.237, 95%CI 1.3-3.6, P = 0.001), severe pneumonia (aOR3.0, 95%CI 1.0-9.3, P = 0.047) and use of gentamycin (aOR6.8, 95%CI 1.3-9.3, P = 0.02). Complete resolution of renal dysfunction at the fourteenth day was seen in 83.1% of the neonates while 16.9% had persistence of renal dysfunction. Ultrasound scan were performed among 105 participants with AKI revealed increased echogenicity, mild hydronephrosis and ectopic kidneys in 25 (23.8%), 4 (3.8%) and 2 (1.9%) respectively. In-hospital mortality was significantly higher among neonates with AKI (70.6%) as compared to those without (29.4%) p< 0.001. AKI was noted in a third of critically ill neonates, with neonatal sepsis, severe pneumonia and use of gentamycin as independent predictors of AKI. Neonates who suffered AKI had twice as much mortality as compared to those without.