The Impact of Increased Awareness of Acute Kidney Injury in the Neonatal Intensive Care Unit on Acute Kidney Injury Incidence and Reporting: Results of a Retrospective Cohort Study

OBJECTIVE: To evaluate the impact of nephrology integration in the NICU on acute kidney injury (AKI) incidence, provider reporting, and nephrology referral. STUDY DESIGN: Cohort study in a single-center NICU from January 2012 to December 2017 (n=1464). We assessed the impact of clinical practice changes including neonatal-nephrology rounds on the incidence of AKI. RESULTS: AKI occurred in 318 neonates (22%). AKI occurred less frequently in those admitted after clinical practice changes (P<.001). After multivariable adjustment, clinical practice changes were associated with reduced odds of AKI (adjusted odds ratio, 0.31;95% CI 0.22–0.44, P<.001). Provider reporting of AKI improved (P<.001) and more neonates were referred for nephrology follow-up (P<.001). CONCLUSIONS: Increased nephrology integration in the NICU was associated with decreased AKI incidence. While recognition of AKI improved, AKI remained poorly reported and nephrology AKI follow-up did not routinely occur. This study supports the importance of increased nephrology involvement in the NICU.