Acute kidney injury is associated with subsequent infection in neonates after the Norwood procedure: a retrospective chart review

Megan SooHoo, Benjamin Griffin, Anna Jovanovich, Danielle E. Soranno, Emily Mack, Sonali S. Patel, Sarah Faubel, Katja M. Gist

Research output: Contribution to journalArticlepeer-review

30 Scopus citations

Abstract

Background: Acute kidney injury (AKI) and infection are common complications after pediatric cardiac surgery. No pediatric study has evaluated for an association between postoperative AKI and infection. The objective of this study was to determine if AKI in neonates after cardiopulmonary bypass was associated with the development of a postoperative infection. Methods: We performed a single center retrospective chart review from January 2009 to December 2015 of neonates (age ≤ 30 days) undergoing the Norwood procedure. AKI was defined by the modified neonatal Kidney Disease Improving Global outcomes serum creatinine criteria using (1) measured serum creatinine and (2) creatinine corrected for fluid balance on postoperative days 1–4. Infection, (culture positive or presumed), must have occurred after a diagnosis of AKI and within 60 days of surgery. Results: Ninety-five patients were included, of which postoperative infection occurred in 42 (44%). AKI occurred in 38 (40%) and 42 (44%) patients by measured serum creatinine and fluid overload corrected creatinine, respectively, and was most commonly diagnosed on postoperative day 2. The median time to infection from the time of surgery and AKI was 7 days (IQR 5–14 days) and 6 days (IQR 3–13 days), respectively. After adjusting for confounders, the odds of a postoperative infection were 3.64 times greater in patients with fluid corrected AKI (95% CI, 1.36–9.75; p = 0.01). Conclusions: Fluid corrected AKI was independently associated with the development of a postoperative infection. These findings support the notion that AKI is an immunosuppressed state that increases the risk of infection.

Original languageEnglish (US)
Pages (from-to)1235-1242
Number of pages8
JournalPediatric Nephrology
Volume33
Issue number7
DOIs
StatePublished - Jul 1 2018
Externally publishedYes

Keywords

  • Acute kidney injury
  • Cardiopulmonary bypass
  • Creatinine
  • Infant, Newborn
  • Norwood procedure
  • Retrospective studies

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

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