Acute kidney injury in preemies tied to poor neurodevelopmental outcomes

Preterm infants with acute kidney injury (AKI) may have poor neurodevelopmental outcomes, according to a study.

Researchers conducted a secondary analysis of the Preterm Erythropoietin Neuroprotection Trial (PENUT). PENUT was a phase III placebo-controlled randomized clinical trial of erythropoietin involving 941 extremely premature neonates born at 24 to 27 weeks’ gestation, recruited at 30 neonatal intensive care units in the US.

The primary outcome was the composite of death or moderate to severe neurodevelopmental impairment (moderate to severe cerebral palsy, Bayley Scales of Infant Development Third Edition [BSID-III] cognitive score <85, or BSID-III motor score <85) at 22 to 26 months’ corrected gestational age. The individual components of the composite outcome were also assessed as secondary outcomes.

A total of 660 enrolled neonates had a follow-up visit with available BSID-III data. AKI was documented in 256 neonates (39 percent). Compared with controls without the condition, neonates with AKI were more likely to be male (57 percent vs 47.5 percent), have lower mean gestational age (25.1 vs 25.7 weeks), lower birth weight (755.3 vs 824.8 g), and an Apgar score of <5 at 5 minutes (24.1 percent vs 17.1 percent).

AKI was associated with greater odds of the composite outcome (adjusted odds ratio [AOR], 1.53, 95 percent confidence interval [CI], 1.07–2.18) and having cognitive BSID-III scores <85 (AOR, 1.94, 95 percent CI, 1.25–2.99). Neither the stage nor timing of AKI had an association with neurodevelopmental impairment.