ABSTRACT
Acute Renal Injury [AKI] is a frequent clinical condition in the Neonatal Intensive Care Units [NICUs]. Most AKI causes are preventable; performing rapid preventive, diagnostic, and therapeutic measures could prevent the potential complications. The present study was conducted to define the risk factors and mortality rates of neonates with and without AKI admitted in the NICU of a tertiary care hospital. Demographic and biochemical data of NICU of Mahdieh Hospital were collected and analyzed. More than twofold increase in normal serum creatinine level or >0.8 mg/dl [for infants > 4 days age] was defined as AKI. All newborns were divided into two groups: with and without AKI. Risk factors and mortality rates were compared in the 2 groups. The mortality rate of newborns with AKI was 4.5%. The other risk factors for mortality in neonates with AKI were as follows: Hyaline Membrane Disease [HMD] [P <0.03], using mechanical ventilation [P <0.041], using surfactant [P <0.04], first minute Apgar score <5, PC02 >60 mmHg [P <0.035], birth weight < 2500 g [P <0.003] and serum creatinine [SCr] level >1 mg/dl [P <0.003]. ROC Curve revealed that low birth weight was the most significant risk factor for mortality of neonates with AKI admitted in the NICU. Mortality related to AKI was associated with HMD, using mechanical ventilation, the need to surfactant use, low Apgar score, high blood PC02, high serum creatinine level, and low birth weight
ABSTRACT
Clinical Risk Index of Babies [CRIB], Score for Neonatal Acute Physiology [SNAP], an update of the Clinical Risk Index for Babies score [CRIB II] and Score for Neonatal Acute Physiology - Perinatal Extension [SNAP-PE] are scoring devices developed in neonatal intensive care units. This study reviewed these scoring systems in critically ill neonates to determine how well they could predict mortality. This prospective cohort study was conducted at the neonatal intensive care units of Mofid and Mahdieh hospitals between March 2006 and May 2009. We evaluated CRIB, CRIB II, SNAP, SNAPII and SNAP-PE score for each neonate and the final scores were then obtained. The predictive accuracy of these parameters were expressed as area under the receiver operative characteristic curve, sensitivity, specificity, positive predictive value and negative predictive value. Of 404 neonate evaluated 53% were male. Primary diagnoses were respiratory distress syndrome, gastrointestinal obstruction, sepsis, prematurity, and neuromuscular diseases. The authors detected mortality in 20.5% and found a significant difference in scoring systems between survived and death groups. The mean CRIB score in survived neonates was 2.57 +/- 3.66 and in death neonates 8.43 +/- 4.66 [p value<0.001]. We also found that the SNAP score had the highest area under the curve and the highest sensitivity, specificity, positive predictive value, negative predictive value and we had the lowest score for CRIB II. We concluded that the neonatal scoring systems could be a useful tool for prediction of mortality in NICUs and SNAP can predict the mortality better than the others