Caffeine Exposure and Risk of Acute Kidney Injury in a Retrospective Cohort of Very Low Birth Weight Neonates

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• 作者：J. Bryan Carmody ; MD ; MPH¹ ; Matthew W. Harer ; MD² ; Anna R. Denotti ; MD³ ; Jonathan R. Swanson ; MD ; MS² ; Jennifer R. Charlton ; MD ; MS⁴ ; ^{jrc6n@virginia.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：AKI ; Acute kidney injury ; CRIB II ; Updated clinical risk index for babies ; GFR ; Glomerular filtration rate ; KDIGO ; Kidney Disease ; Improving Global Outcomes ; NICU ; Neonatal intensive care unit ; SGA ; Small for gestational age ; VLBW ; Very low birth weight
• 刊名：The Journal of Pediatrics
• 出版年：2016
• 出版时间：May 2016
• 年：2016
• 卷：172
• 期：Complete
• 页码：63-68.e1
• 全文大小：283 K

文摘

To evaluate the association between caffeine exposure and acute kidney injury (AKI) in very low birth weight (VLBW; ≤1500 g) neonates.

Study design

We retrospectively reviewed a cohort of 140 VLBW neonates consecutively admitted to the University of Virginia's neonatal intensive care unit from March 2011 to June 2012, excluding only those admitted >2 days of age or who died at <2 days after birth. We separately analyzed a subgroup of 44 neonates who received prolonged invasive respiratory support (mechanical ventilation for first 7 days after birth). The exposure of interest was caffeine exposure in the first week after birth. The primary outcome was AKI within the first 10 days after birth according to the Kidney Disease: Improving Global Outcomes system, modified to include only serum creatinine.

Results

Caffeine exposure occurred in 72.1% of all patients and 54.5% of those who received prolonged invasive respiratory support. AKI occurred less frequently in neonates who received caffeine (all patients: 17.8% vs 43.6%; P = .002; prolonged invasive respiratory support: 29.2% vs 75.0%; P = .002). Caffeine exposure was associated with decreased odds for AKI in logistic regression models adjusted for sex, birth weight, gestational age, small for gestational age status, illness severity on admission, and receipt of indomethacin, invasive ventilation, dopamine, aminoglycosides, and vancomycin (all patients: OR 0.22; 95% CI 0.07-0.75, P = .02; prolonged invasive respiratory support subgroup: OR 0.06; 95% CI 0.01-0.57, P = .02).

Conclusions

In a cohort of VLBW neonates, those exposed to caffeine were less likely to experience AKI.