Iatrogenic Risk Factors for Acute Kidney Injury in Critically Ill Neonates | ||
| Medicine Updates | ||
| Articles in Press, Accepted Manuscript, Available Online from 16 November 2025 | ||
| Document Type: Original Article | ||
| DOI: 10.21608/muj.2025.435681.1279 | ||
| Authors | ||
| Sara Asaad Elmeniawy1; Gamal Taha Soliman2; Hafez Bazara3; Rasha Emad Amin4; Noha Hassan EL-Anwar* 5 | ||
| 1Pediatric and neonatology specialist, Ministry of health and population , Damietta, Egypt. | ||
| 2Professor of Pediatrics & Head of Pediatric Department, Faculty of Medicine, Port Said University. | ||
| 3Professor of Pediatrics and Pediatric Critical care, Faculty of Medicine, Cairo University, Cairo, Egypt. | ||
| 4Assistant Professor of Clinical and Chemical Pathology. Faculty of Medicine, Port Said University. | ||
| 5Pediatric department, Faculty of medicine, Cairo University, Cairo, Egypt. | ||
| Abstract | ||
| Background: Neonates, especially preterm newborns, are highly susceptible to acute kidney injury (AKI) due to immature renal function. The etiology of AKI is multifactorial, and outcomes vary with cause and severity. Aim: To determine the incidence and iatrogenic risk factors of AKI among critically ill neonates admitted to the NICU. Patients and Methods: Sixty-five critically ill full-term and preterm neonates admitted to the NICU of Damietta Specialized Hospital were included. Urinary β2-microglobulin using the ELISA technique, were collected on days 2 and 7 of NICU admission, with other demographic, clinical, and laboratory data were recorded. Results: AKI developed in 56.9% of the studied neonates, with a strong association with hypoxia. Hypoxic neonates had nearly fivefold higher risk of AKI. Those with AKI exhibited significant oliguria on days 2 and 7 of admission. AKI occurrence correlated with the use of medications such as adrenaline, midazolam, and phenobarbitone, as well as the need for endotracheal intubation and urinary catheterization. Urinary β2-microglobulin levels were significantly higher in the AKI group on both day 2 and day 7 and, along with higher Vasoactive-Inotropic Scores, predicted AKI development. A urinary β2-microglobulin cutoff of 0.1245 µg/ml on day 2 and 0.959 µg/ml on day 7 demonstrated strong predictive ability (AUC = 0.854), with sensitivities of 86.5% and 67.6% and specificities of 78.6% and 82.1%, respectively. Conclusion: AKI is common among critically ill neonates, particularly those exposed to hypoxia or receiving intensive interventions. Urinary β2-microglobulin serves as a significant early biomarker for predicting AKI in NICU patients. | ||
| Keywords | ||
| Acute Kidney Injury; Urinary β2 microglobulin; NICU; Risk Factors | ||
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