Abstract
Introduction: Daily urinary output (UOP) serves as important tool to identify acute kidney injury (AKI) in preterm infants. However, reference values for UOP, especially stratified for gestational age (GA), are missing. Methods: This retrospective single-center study assessed UOP during the first 28 days of life in 128 very low birth weight (VLBW) infants. Results: VLBW infants exhibit a highly dynamic daily UOP profile in the first 28 days of life with a maximum at day 12 with 4.78 mL/kg bodyweight/h. In the subcohort of 64 extremely low gestational age neonates (ELGANs), the highest UOP is measured during the second week of life. Infants born before 24 weeks of gestation have significantly higher UOP than more mature infants. Conclusion: UOP is dynamic in the postnatal period and differs significantly between GA cohorts in the subgroup of ELGANs. These data might point to an adaption of the UOP threshold for neonatal AKI in preterm infants.
Journal Section:
Brief Report
References
1.
Wu
Y
, Wang
H
, Pei
J
, Jiang
X
, Tang
J
. Acute kidney injury in premature and low birth weight neonates: a systematic review and meta-analysis
. Pediatr Nephrol
. 2022
;37
(2
):275
–87
. 2.
Kaddourah
A
, Basu
RK
, Bagshaw
SM
, Goldstein
SL
; AWARE Investigators
. Epidemiology of acute kidney injury in critically ill children and young adults
. N Engl J Med
. 2017
;376
(1
):11
–20
. 3.
Jetton
JG
, Boohaker
LJ
, Sethi
SK
, Wazir
S
, Rohatgi
S
, Soranno
DE
, et al. Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicentre, multinational, observational cohort study
. Lancet Child Adolesc Health
. 2017
;1
(3
):184
–94
. 4.
Hirano Arruda Moraes
L
, Jornada Krebs
VL
, de Carvalho
WB
. Risk factors for acute kidney injury in very-low birth weight newborns: a systematic review with meta-analysis
. Eur J Pediatr
. 2024
;183
(8
):3243
–51
. 5.
De Mul
A
, Heneau
A
, Biran
V
, Wilhelm-Bals
A
, Parvex
P
, Poncet
A
, et al. Early urine output monitoring in very preterm infants to predict in-hospital neonatal outcomes: a bicentric retrospective cohort study
. BMJ Open
. 2023
;13
(1
):e068300
. 6.
Zappitelli
M
, Ambalavanan
N
, Askenazi
DJ
, Moxey-Mims
MM
, Kimmel
PL
, Star
RA
, et al. Developing a neonatal acute kidney injury research definition: a report from the NIDDK neonatal AKI workshop
. Pediatr Res
. 2017
;82
(4
):569
–73
. 7.
Hingorani
S
, Schmicker
RH
, Brophy
PD
, Heagerty
PJ
, Juul
SE
, Goldstein
SL
, et al. Severe acute kidney injury and mortality in extremely low gestational age neonates
. Clin J Am Soc Nephrol
. 2021
;16
(6
):862
–9
. 8.
Harer
MW
, Charlton
JR
. Urine or you’re out? Perspectives on urinary output thresholds in the neonatal acute kidney injury definition
. Clin J Am Soc Nephrol
. 2022
;17
(7
):939
–41
. 9.
Burgmaier
K
, Zeiher
M
, Weber
A
, Cosgun
ZC
, Aydin
A
, Kuehne
B
, et al. Low incidence of acute kidney injury in VLBW infants with restrictive use of mechanical ventilation
. Pediatr Nephrol
. 2024
;39
(4
):1279
–88
. 10.
Charlton
JR
, Boohaker
L
, Askenazi
D
, Brophy
PD
, D’Angio
C
, Fuloria
M
, et al. Incidence and risk factors of early onset neonatal AKI
. Clin J Am Soc Nephrol
. 2019
;14
(2
):184
–95
. 11.
De Mul
A
, Parvex
P
, Heneau
A
, Biran
V
, Poncet
A
, Baud
O
, et al. Urine output monitoring for the diagnosis of early-onset acute kidney injury in very preterm infants
. Clin J Am Soc Nephrol
. 2022
;17
(7
):949
–56
. 12.
Louis
D
, Dey
A
, Jain
A
. Association between changes in urine output and successful indomethacin treatment for patent ductus arteriosus in preterm neonates
. J Paediatr Child Health
. 2021
;57
(4
):554
–8
. 13.
Araya
BR
, Ziegler
AA
, Grobe
CC
, Grobe
JL
, Segar
JL
. Sodium and growth in preterm infants: a review
. Newborn
. 2023
;2
(2
):142
–7
. 14.
Gattineni
J
, Baum
M
. Developmental changes in renal tubular transport-an overview
. Pediatr Nephrol
. 2015
;30
(12
):2085
–98
. 15.
Sutherland
MR
, Black
MJ
. The impact of intrauterine growth restriction and prematurity on nephron endowment
. Nat Rev Nephrol
. 2023
;19
(4
):218
–28
. 16.
Mishra
G
, Chandrashekhar
SR
. Management of diabetes insipidus in children
. Indian J Endocrinol Metab
. 2011
;15
(Suppl 3
):S180
–7
. 17.
Allegaert
K
, Smits
A
, van Donge
T
, van den Anker
J
, Sarafidis
K
, Levtchenko
E
, et al. Renal precision medicine in neonates and acute kidney injury: how to convert a cloud of creatinine observations to support clinical decisions
. Front Pediatr
. 2020
;8
:366
. 18.
Bezerra
CT
, Vaz Cunha
LC
, Liborio
AB
. Defining reduced urine output in neonatal ICU: importance for mortality and acute kidney injury classification
. Nephrol Dial Transpl
. 2013
;28
(4
):901
–9
. 19.
Klein
R
, Fastnacht
L
, Kribs
A
, Kuehne
B
, Mehler
K
. LISA eligibility and LISA success in extremely preterm infants: a single-center experience
. Neonatology
. 2024
;121
(4
):530
–5
. 20.
Mehler
K
, Grimme
J
, Abele
J
, Huenseler
C
, Roth
B
, Kribs
A
. Outcome of extremely low gestational age newborns after introduction of a revised protocol to assist preterm infants in their transition to extrauterine life
. Acta Paediatr
. 2012
;101
(12
):1232
–9
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