Relationship of Patent Ductus Arteriosus Management with Neonatal AKI

OBJECTIVE: Investigate relationship between management of patent ductus arteriosus (PDA) and acute kidney injury (AKI) in very low birthweight neonates. STUDY DESIGN: Retrospective cohort study of neonates, <1500g, admitted to 24 NICUs, 1/1/14 – 3/31/14. AKI diagnosed using the neonatal modified KDIGO definition; diagnosis and treatment of PDA extracted from the medical record. Demographics, clinical characteristics, and AKI stage compared using chi-square and analysis of variance. A general estimating equation logistic regression used to estimate adjusted odds ratios. RESULTS: Of 526 neonates with sufficient data to diagnose AKI, 157 (30%) had PDA (61 conservative management, 62 pharmacologic treatment only, 34 surgical ligation). In analyses adjusted for sex, birthweight, gestational age, caffeine, nephrotoxin exposure, vasopressor and mechanical ventilation use, with conservative management as reference, there were no differences among treatment cohorts in the odds of AKI. CONCLUSION: The underlying physiology of PDA, not management strategy, may determine the likelihood of AKI in neonates <1500 grams.