Renal oximetry for early acute kidney injury detection in neonates with hypoxic ischemic encephalopathy receiving therapeutic hypothermia.

BACKGROUND: Neonates with hypoxic ischemic encephalopathy (HIE) receiving therapeutic hypothermia are at high risk of acute kidney injury (AKI). METHODS: We performed a two-site prospective observational study from 2018 to 2019 to evaluate the utility of renal near-infrared spectroscopy (NIRS) in detecting AKI in 38 neonates with HIE receiving therapeutic hypothermia. AKI was defined by a delayed rate of serum creatinine decline (< 33% on day 3 of life, < 40% on day 5, and < 46% on day 7). Renal saturation (Rsat) and systemic oxygen saturation (SpO2) were continuously measured for the first 96 h of life (HOL). Renal fractional tissue oxygen extraction (RFTOE) was calculated as (SpO2 - Rsat)/(SpO2). Using renal NIRS, urine biomarkers, and perinatal factors, logistic regression was performed to develop a model that predicted AKI. RESULTS: AKI occurred in 20 of 38 neonates (53%). During the first 96 HOL, Rsat was higher, and RFTOE was lower in the AKI group vs. the no AKI group (P < 0.001). Rsat > 70% had a fair predictive performance for AKI at 48-84 HOL (AUC 0.71-0.79). RFTOE ≤ 25 had a good predictive performance for AKI at 42-66 HOL (AUC 0.8-0.83). The final statistical model with the best fit to predict AKI (AUC = 0.88) included RFTOE at 48 HOL (P = 0.012) and pH of the infants' first postnatal blood gas (P = 0.025). CONCLUSIONS: Lower RFTOE on renal NIRS and pH on infant first blood gas may be early predictors for AKI in neonates with HIE receiving therapeutic hypothermia. A higher resolution version of the Graphical abstract is available as Supplementary information.

A community-based participatory approach to youth development and school climate change: the alignment enhanced services project.

BACKGROUND: School-community partnerships offer an opportunity to promote positive youth development. However, there is a need for community-based participatory research (CBPR) models that leverage community and school resources to create environments that support youths' success. OBJECTIVE: Describe the CBPR process used by Alignment Enhanced Services (AES) partners to develop and implement a strategy to promote a positive school climate, and to discuss factors that influence the AES process in the schools. METHODS: A committee of school and community members developed the AES process, which included an environmental scan that solicited input from internal and external stake-holders on the schools' assets and needs related to youth development and school climate. AES coordinators, in consultation with school administrators, developed and implemented action plans that leveraged each school's existing strengths, while identifying and utilizing new resources to address systemic and individual needs. LESSONS LEARNED: To date, the project has produced encouraging results; however, the AES process resulted in numerous challenges for the coordinators, schools, and community partners. CONCLUSION: AES offers a method for engaging the stakeholders in addressing critical issues related to youth development and school climate.