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Abstract Background Neonatal AKI (Acute kidney injury) is an underreported entity in sick neonates associated with significant morbidity and mortality. Methods It was a prospective cohort study, to study the incidence, risk factors, and outcomes of AKI among sick neonates. We included sick inborn neonates admitted at a level III neonatal intensive care unit. Neonates with congenital anomalies and who died within 72 hours of life were excluded. AKI was defined and categorized as per KDIGO guidelines. Results Two hundred and seventy-six neonates were enrolled over 1 year, of which 115(42%) had AKI. AKI was higher in the first week of life as compared to beyond the first week n = 103/115 (89%) vs. n = 12/115 (7%), p = < 0.01). The incidence of AKI was highest n = 27/38 (71%) among extremely preterm (< 28 weeks) infants. On Cox regression analysis, sepsis, invasive ventilation, acidosis, and perinatal asphyxia were significantly associated with AKI with a hazard ratio (95% CI) of 4 (1.21–13.42), 2.3 (1.32–4.03), 1.9 (1.13–3.36), and 1.5 (1.04–2.31), respectively. The risk prediction model, using the 4 predictors mentioned above, had good diagnostic accuracy (area under the curve- 83.6%) with a sensitivity and specificity of 77% and 80%, respectively. Infants with AKI have significantly higher mortality, compared to those who did not have AKI n = 45/115(39%) vs. n = 5/161 (3%), p < 0.01. Conclusion Nearly half of sick neonates admitted to NICU have AKI, and is maximum in extremely preterm infants. Sepsis, invasive ventilation, acidosis, and perinatal asphyxia have good diagnostic accuracy in identifying neonates likely to develop AKI.
Ramya et al. (Sun,) studied this question.