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

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.