Neonatal Acute Kidney Injury: A Survey of Perceptions and Management Strategies Amongst Pediatricians and Neonatologists

Sidharth Kumar Sethi; Gopal Agrawal; Sanjay Wazir; Smriti Rohatgi; Arpana Iyengar; Ronith Chakraborty; Rahul Jain; Nikhil Nair; Rajiv Sinha; Raktima Chakrabarti; Deepak Kumar; Rupesh Raina

doi:10.3389/fped.2019.00553

Neonatal Acute Kidney Injury: A Survey of Perceptions and Management Strategies Amongst Pediatricians and Neonatologists

Front Pediatr. 2020 Jan 14:7:553. doi: 10.3389/fped.2019.00553. eCollection 2019.

Authors

Affiliations

¹ Department of Pediatric Nephrology, Medanta the Medicity, Gurgaon, India.
² Department of Pediatrics and Neonatology, Cloudnine Hospital, Gurgaon, India.
³ Department of Pediatrics, St. John's National Academy of Health Sciences, Bengaluru, India.
⁴ Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, United States.
⁵ Saint Ignatius High School, Cleveland, OH, United States.
⁶ Department of Chemistry, Case Western Reserve University, Cleveland, OH, United States.
⁷ Department of Pediatric Medicine, Institute of Child Health, Kolkata, India.
⁸ Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States.
⁹ Department of Nephrology, Akron Children's Hospital, Akron, OH, United States.

Abstract

Background: Neonatal Acute Kidney Injury (AKI) occurs in 40-70% of critically ill newborn infants and is independently associated with increased morbidity and mortality. Understanding the practice patterns of physicians (neonatologists and pediatricians), caring for neonates in India is important to optimize care and outcomes in neonatal AKI. Aim: The aim of this study was to identify differences in physician's perception and practice variations of diagnosis, management, and follow-up of newborn infants with AKI in India. Methods: An online survey of neonatologists and pediatricians in India caring for newborn infants with AKI. Results: Out of 800 correspondents, 257 (135 neonatologists and 122 pediatricians) completed the survey, response rate being 32.1%. Resources available to the respondents included level III NICU (59%), neonatal surgery (60%), dialysis (11%), and extracorporeal membrane oxygenation (ECMO, 3%). Most respondents underestimated the risk of AKI due to various risk factors such as prematurity, asphyxia, sepsis, cardiac surgery, and medications. Less than half the respondents were aware of the AKIN or KDIGO criteria, which are the current standard criteria for defining neonatal AKI. Only half of the respondents were aware of the risk of CKD in preterm neonates and nearly half were unaware of the need to follow up with a pediatric nephrologist. Conclusions: Similar to other regions worldwide, there exists a knowledge gap in early recognition, optimal management and follow up of newborn infants with AKI amongst Indian physicians.

Keywords: AKI; acute kidney injury; dialysis; neonatal; preterm; survey.