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Pediatr Nephrol. 2018 Jul;33(7):1235-1242. doi: 10.1007/s00467-018-3907-5. Epub 2018 Mar 5.

Acute kidney injury is associated with subsequent infection in neonates after the Norwood procedure: a retrospective chart review.

Author information

1
Department of Pediatrics, Children's Hospital Colorado, The Heart Institute, University of Colorado, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA.
2
Renal Division, Department Medicine, University of Colorado, Aurora, CO, USA.
3
Denver VA Medical Center, Denver, CO, USA.
4
Department of Pediatrics, Children's Hospital Colorado, The Kidney Center, University of Colorado, Aurora, CO, USA.
5
Department of Pediatrics, Children's Hospital Colorado, The Heart Institute, University of Colorado, 13123 E 16th Ave, B100, Aurora, CO, 80045, USA. Katja.gist@childrenscolorado.org.

Abstract

BACKGROUND:

Acute kidney injury (AKI) and infection are common complications after pediatric cardiac surgery. No pediatric study has evaluated for an association between postoperative AKI and infection. The objective of this study was to determine if AKI in neonates after cardiopulmonary bypass was associated with the development of a postoperative infection.

METHODS:

We performed a single center retrospective chart review from January 2009 to December 2015 of neonates (age ≤ 30 days) undergoing the Norwood procedure. AKI was defined by the modified neonatal Kidney Disease Improving Global outcomes serum creatinine criteria using (1) measured serum creatinine and (2) creatinine corrected for fluid balance on postoperative days 1-4. Infection, (culture positive or presumed), must have occurred after a diagnosis of AKI and within 60 days of surgery.

RESULTS:

Ninety-five patients were included, of which postoperative infection occurred in 42 (44%). AKI occurred in 38 (40%) and 42 (44%) patients by measured serum creatinine and fluid overload corrected creatinine, respectively, and was most commonly diagnosed on postoperative day 2. The median time to infection from the time of surgery and AKI was 7 days (IQR 5-14 days) and 6 days (IQR 3-13 days), respectively. After adjusting for confounders, the odds of a postoperative infection were 3.64 times greater in patients with fluid corrected AKI (95% CI, 1.36-9.75; p = 0.01).

CONCLUSIONS:

Fluid corrected AKI was independently associated with the development of a postoperative infection. These findings support the notion that AKI is an immunosuppressed state that increases the risk of infection.

KEYWORDS:

Acute kidney injury; Cardiopulmonary bypass; Creatinine; Infant, Newborn; Norwood procedure; Retrospective studies

PMID:
29508077
PMCID:
PMC6326095
[Available on 2019-07-01]
DOI:
10.1007/s00467-018-3907-5

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