Author/Authors :
Mohkam, Masoumeh Pediatric Infections Research Center - Shahid Beheshti University of Medical Sciences - Tehran, Iran , Kompani, Farshid Chronic Disease Care Research Center - Ahvaz Jundishapur University of Medical Sciences - Ahvaz, Iran , Afjeii, Abolfazl Chronic Disease Care Research Center - Ahvaz Jundishapur University of Medical Sciences - Ahvaz, Iran , Golchin, Fatemeh Chronic Disease Care Research Center - Ahvaz Jundishapur University of Medical Sciences - Ahvaz, Iran , Abdollah Gorji, Fatemeh Chronic Disease Care Research Center - Ahvaz Jundishapur University of Medical Sciences - Ahvaz, Iran
Abstract :
Diagnosis of neonatal acute renal failure (ARF) is a difficult dilemma. Traditionally neonatal ARF was defined as urine output of less than 1 ml/kg/hr together with a serum creatinine level of greater than 1.5 mg/dl for at least 24 hours. Early diagnosis and prompt treatment of ARF in NICUs can decrease the rate of mortality and morbidity in neonates. Based on RIFLE criteria the definition of ARF is changed lately in adult and pediatric groups. Studies to evaluate the RIFLE criteria in the definition of neonatal ARF have not been performed. The aim of this study was to compare the RIFLE criteria to the old definition of ARF in neonates in the diagnosis of neonatal acute kidney injury (AKI) and the prediction of mortality. Materials and Methods: This cohort study was conducted on 904 critically ill neonates. The author determined the RIFLE score for each neonate based on serum creatinine and urine output at the second day of admission. Prevalence of AKI was determined based on old definition of ARF and RIFLE criteria separately. Results: Based on RIFLE criteria, 22.5% of study group had normal renal function and 77.5% had AKI at the second day of admission. Among patients with AKI 43% met the risk, 51% the injury and about 6% the failure criterion. Based on old definition of ARF in neonates, the rate of ARF in our study group was 3.2%. There was a significant difference between AKI prevalence by RIFLE criteria and the former definition (P<0.001). The overall mortality rate in critically ill neonates was 14%. Of those who died, 81.9% had AKI. In patients with normal renal function there was no mortality and in patients with AKI based on RIFLE criteria the mortality rate was 21.7% (P<0.031, Odds Ratio=1.103, 95% CI=1.05-1.16) and in patients with ARF based on old definition the mortality rate was 61.5% (P<0.001, Odds Ratio=6.741). A progressive and significant increase in the mortality was correlated with increasing severity of ARF as determined by RIFLE criteria in all neonates. Conclusions: RIFLE criteria can detect neonatal AKI earlier and is a good predictor for mortality in critically ill neonates.
