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J Pediatr. 2019 Dec;215:223-228.e6. doi: 10.1016/j.jpeds.2019.08.046.

Baby NINJA (Nephrotoxic Injury Negated by Just-in-Time Action): Reduction of Nephrotoxic Medication-Associated Acute Kidney Injury in the Neonatal Intensive Care Unit.

Author information

1
Department of Pediatrics, University of Alabama at Birmingham; Department of Pediatrics, Children's of Alabama. Electronic address: christinestoops@uabmc.edu.
2
Department of Pediatrics, Children's of Alabama.
3
Department of Pediatrics, Children's of Alabama; The Pediatric and Infant Center for Acute Nephrology (PICAN).
4
Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL.
5
Department of Pediatrics, Cincinnati Children's Hospital Medical Center; Center for Acute Care Nephrology (CACN), Cincinnati, OH.
6
Department of Pediatrics, University of Alabama at Birmingham; Department of Pediatrics, Children's of Alabama.
7
Department of Pediatrics, University of Alabama at Birmingham; Department of Pediatrics, Children's of Alabama; The Pediatric and Infant Center for Acute Nephrology (PICAN).

Abstract

OBJECTIVE(S):

To test if acute kidney injury (AKI) is preventable in patients in the neonatal intensive care unit and if infants at high-risk of nephrotoxic medication-induced AKI can be identified using a systematic surveillance program previously used in the pediatric non-intensive care unit setting.

STUDY DESIGN:

Quality improvement project that occurred between March 2015 and September 2017 in a single center, level IV neonatal intensive care unit. Infants were screened for high-risk nephrotoxic medication exposure (≥3 nephrotoxic medication within 24 hours or ≥4 calendar days of an intravenous [IV] aminoglycoside). If infants met criteria, a daily serum creatinine (SCr) was obtained until 2 days after end of exposure or end of AKI, whichever occurred last. The study was divided into 3 eras: pre-Nephrotoxic Injury Negated by Just-in-time Action (NINJA), initiation, and sustainability. Differences for 5 metrics across 3 eras were compared: SCr surveillance, high nephrotoxic medication exposure rate (per 1000 patient-days), AKI rate (per 1000 patient-days), nephrotoxin-AKI percentage, and AKI intensity (number of AKI days per 100 susceptible patient-days).

RESULTS:

Comparing the initiation with sustainability era, there was a reduction in high nephrotoxic medication exposures from 16.4 to 9.6 per 1000 patient-days (P = .03), reduction in percentage of nephrotoxic medication-AKI from 30.9% to 11.0% (P < .001), and reduction in AKI intensity from 9.1 to 2.9 per 100 susceptible patient-days (P < .001) while maintaining a high SCr surveillance rate. This prevented 100 AKI episodes during the 18-month sustainability era.

CONCLUSION(S):

A systematic surveillance program to identify high-risk infants can prevent nephrotoxic-induced AKI and has the potential to prevent short and long-term consequences of AKI in critically ill infants.

KEYWORDS:

acute renal failure; neonate

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