# Etiological Profile and Short-Term Outcomes of Acute Kidney Injury in Term Neonates at a Tertiary Care Centre in Western Maharashtra, India

## TL;DR

This study examines the causes and outcomes of acute kidney injury in term newborns at a hospital in India, finding that sepsis and low birth weight are major contributors with high mortality rates.

## Contribution

The study provides a detailed etiological profile and outcome analysis of AKI in term neonates in a specific Indian region.

## Key findings

- Sepsis or multiple organ dysfunction syndrome was the most common cause of AKI in term neonates.
- Mortality was significantly higher in neonates with sepsis or perinatal hypoxia compared to other causes.
- Urinary tract obstructions and infections generally had better outcomes compared to other AKI causes.

## Abstract

Background

Acute kidney injury (AKI) is characterized by a sudden decline in kidney function, leading to a reduced glomerular filtration rate (GFR). This decline results in the accumulation of nitrogenous waste products in the blood, disturbs electrolyte balance, and disrupts fluid regulation.

Objective

To determine the etiological profile of AKI in term neonates.

Methods

A prospective observational study was conducted at the Neonatal Intensive Care Unit (NICU) of our tertiary care hospital and referral and teaching center. The study spanned a period of two years, from August 2022 to July 2024, and comprised a total of 78 term babies diagnosed with AKI, all of whom were enrolled after obtaining consent using a predefined proforma. The neonatal period was defined as the time from birth up to 44 weeks of postmenstrual age (PMA), encompassing a critical developmental phase in newborns.

Results

In our study of 78 term neonates with AKI, we found a predominant occurrence in males (53, 67.9%) and a significant proportion with low birth weights (41, 52.6%). The most common cause of AKI was sepsis or multiple organ dysfunction syndrome (MODS) (32, 41%), followed by perinatal hypoxia (14, 17.9%) and urinary tract obstructions (12, 15.3%). Urinary tract infections (UTIs) accounted for nine cases (11.5%), hypernatremic dehydration for six cases (7.6%), acute tubular necrosis for three cases (3.8%), and congenital polycystic kidney disease for two cases (2.9%). Mortality was notably high, with 20 neonates (25.7%) dying from AKI, particularly those with sepsis/MODS and perinatal hypoxia. However, conditions such as urinary tract obstructions and UTIs generally had better outcomes. The statistical analysis revealed a significant association between the underlying etiology and outcomes (p<0.001), underscoring the importance of prompt and targeted interventions for different AKI causes in neonates.

Conclusion

Our findings highlight the diverse etiological spectrum of AKI in term neonates and its significant impact on mortality. Early recognition, appropriate management, and targeted interventions tailored to the underlying cause are crucial in improving outcomes for neonates with AKI.