115 - Acute kidney injury in infants with hypoxic ischemic encephalopathy

Poster Number: 115
Publication Number: 115.125

Marwa M. Elgendy, Cleveland Clinic Children's Hospital, cleveland, OH, United States; Mohamed A. Mohamed, Cleveland Clinic Children's, Cleveland, OH, United States; Hany Aly, Cleveland Clinic Children's Hospital, Cleveland, OH, United States

Background: Hypoxic ischemic encephalopathy (HIE) may be associated with acute kidney injury (AKI). Few reports described the impact of AKI on increased mortality or prolonged length of stay (LOS) among infants with HIE.

Objective: To describe the prevalence of AKI in infants with HIE and to examine its impact on mortality and LOS in a large U.S. dataset.

Design/Methods: We used the national inpatient sample (NIS) dataset produced by the healthcare cost and utilization project (HCUP) for the years 2010-2018. We identified AKI using the ICD-9 codes 584.5, 584.6, 584.7, 584.8, 584.9, 586 and 7885 and the ICD-10 codes N17.0, N17.1, N17.2, N17.4, N17.5, N19 and R34. We identified HIE using ICD-9 codes 768.5, 768.9, 768.70, 768.71, 768.72, 768.73 and ICD-10 codes P91.63, P91.62, P91.61 and P91.60. We included discharge records of infants with GA > 36 weeks and BW > 2500g. We excluded infants with congenital diaphragmatic hernia, heart disease, abdominal wall defects, central nervous system, renal or pulmonary anomalies. We excluded infants with complex congenital anomalies, common syndromes and chromosomal disorders. Odds ratios (OR) to have AKI in association with HIE were calculated using chi square test. Logistic regression models were used to calculate adjusted OR (aOR) while controlling for confounding variables. Student t test was used to compare LOS between groups.

Results: Weighted sample included 31,220,784 admission records. Of them, 48.8% were females, 46.8% were Caucasians, 98.6% were singleton pregnancy and 31.1% were cesarean section. There were 30,130 (0.1%) infants with any degree of HIE. Infants with AKI were 15,275 (0.05%) of the sample. There were 9.0% of infants with AKI among those with any degree of HIE compared to 0.04% among those with no HIE; aOR 77.6 (CI:70.1-85.7, p< 0.001). Prevalence of AKI was 19.7% among infants with severe HIE, aOR: 130 (CI:107-159), p< 0.001), 6.2% in moderate HIE, aOR: 22.4 (CI:17.6-28.5), p< 0.001), 3.9% in mild HIE, aOR: 40.3 (CI:30.6-53.0, p< 0.001) and 8.3% in infants with HIE not otherwise specified, aOR 51.4 (CI:45.2-58.5, p< 0.001). Among infants with HIE, mortality is increased in those with AKI compared to those without (28.9% vs 8.8%) aOR 4.6 (CI:3.8-5.6, p< 0.001) and LOS is increased in AKI compared to non- AKI (20(+24) versus 13(+14) days, p< 0.001).Conclusion(s): Hypoxic ischemic encephalopathy (HIE) is associated with higher prevalence of AKI compared to general population.  AKI is more common in infants with severe HIE compared to mild or moderate HIE.  AKI is associated with increased mortality and increased LOS in infants with HIE.