Prevalence of Acute Kidney Injury in neonates admitted at a referral hospital, Harare, Zimbabwe

Abstract

Objectives: To determine prevalence of acute kidney injury and associated factors, among neonates admitted at a referral hospital.

Design: Cross sectional study conducted 1 May to 31 July 2010.

Setting: Harare Central Hospital, Neonatal Unit. Subjects: 270 neonates ≥ 37 weeks gestation admitted within 12 hours of birth. Systematic random sampling was used to select study participants.

Methods: Maternal details were collected through an interviewer administered questionnaire. Neonatal clinical examination was performed. Blood for serum creatinine was collected within 12 hours of life and repeated 24-48 hours of life.

Main Outcome Measure:Acute Kidney Injury (AKI) defined by decrease of estimated Glomerular Filtration Rate (GFR) by ≥ 25% from baseline value, using RIFLE criteria (an acronym for Risk, Injury, Failure, Loss and End stage).

Results: The prevalence of AKI in term neonates was 33.3% (95% CI 0.27; 0.39). Factors significantly associated with AKI were Hypoxic Ischaemic Encephalopathy (HIE) 1(OR 3.05 95%CI 1.56;5.97), HIE 2 and 3 (OR 9.57 95%CI 3.83;23.92), APGAR score ≤6 (OR 3.82 95%CI 2.16;6.78), respiratory rate >60 (OR1.96 95%CI 1.09;3.55), chest recessions (OR 2.73 95% CI 1.56;4.75), history of neonatal fits (OR 5.78 95%CI 1.56;4.75),hypothermia (OR 3.05 95%CI 1.56;4.75) and maternal age ≥35 years(OR 5.89 95%CI1.11;31.41). Strong determinants of AKI on multivariate logistic regression analysis were HIE 1, hypothermia and chest recessions.

Conclusion: The prevalence of AKI in term neonates admitted at a Harare hospital was high. It is recommended to assess for AKI in neonates with identified risk factors and monitor for chronic kidney disease.