TY - JOUR
T1 - Mortality Risk Factors among Infants Receiving Dialysis in the Neonatal Intensive Care Unit
AU - Sanderson, Keia R.
AU - Warady, Bradley
AU - Carey, William
AU - Tolia, Veeral
AU - Boynton, Marcella H.
AU - Benjamin, Daniel K.
AU - Jackson, Wesley
AU - Laughon, Matthew
AU - Clark, Reese H.
AU - Greenberg, Rachel G.
N1 - Funding Information:
K.S. is supported by the National Center for Advancing Translational Sciences , National Institutes of Health ( KL2TR002490 ) and the Doris Duke Charitable Foundation ( 2015213 ). M.L. is supported by the National Heart, Lung, and Blood Institute , National Institutes of Health ( K24HL143283 ). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The other authors declare no conflicts of interest.
Publisher Copyright:
© 2021 Elsevier Inc.
PY - 2022/3
Y1 - 2022/3
N2 - Objectives: To identify risk factors associated with mortality for infants receiving dialysis in the neonatal intensive care unit (NICU). Study design: In this retrospective cohort study, we extracted data from the Pediatrix Clinical Data Warehouse on all infants who received dialysis in the NICU from 1999 to 2018. Using a Cox proportional hazards model with robust SEs we estimated the mortality hazard ratios associated with demographics, birth details, medical complications, and treatment exposures. Results: We identified 273 infants who received dialysis. Median gestational age at birth was 35 weeks (interquartile values 33-37), median birth weight was 2570 g (2000-3084), 8% were small for gestational age, 41% white, and 72% male. Over one-half of the infants (59%) had a kidney anomaly; 71 (26%) infants died before NICU hospital discharge. Factors associated with increased risk of dying after dialysis initiation included lack of kidney anomalies, Black race, gestational age of <32 weeks, necrotizing enterocolitis, dialysis within 7 days of life, and receipt of paralytics or vasopressors (all P <.05). Conclusion: In this cohort of infants who received dialysis in the NICU over 2 decades, more than 70% of infants survived. The probability of death was greater among infants without a history of a kidney anomaly and those with risk factors consistent with greater severity of illness at dialysis initiation.
AB - Objectives: To identify risk factors associated with mortality for infants receiving dialysis in the neonatal intensive care unit (NICU). Study design: In this retrospective cohort study, we extracted data from the Pediatrix Clinical Data Warehouse on all infants who received dialysis in the NICU from 1999 to 2018. Using a Cox proportional hazards model with robust SEs we estimated the mortality hazard ratios associated with demographics, birth details, medical complications, and treatment exposures. Results: We identified 273 infants who received dialysis. Median gestational age at birth was 35 weeks (interquartile values 33-37), median birth weight was 2570 g (2000-3084), 8% were small for gestational age, 41% white, and 72% male. Over one-half of the infants (59%) had a kidney anomaly; 71 (26%) infants died before NICU hospital discharge. Factors associated with increased risk of dying after dialysis initiation included lack of kidney anomalies, Black race, gestational age of <32 weeks, necrotizing enterocolitis, dialysis within 7 days of life, and receipt of paralytics or vasopressors (all P <.05). Conclusion: In this cohort of infants who received dialysis in the NICU over 2 decades, more than 70% of infants survived. The probability of death was greater among infants without a history of a kidney anomaly and those with risk factors consistent with greater severity of illness at dialysis initiation.
KW - acute kidney injury
KW - chronic kidney disease
KW - continuous kidney replacement therapy
KW - dialysis
KW - neonatal
KW - peritoneal dialysis
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U2 - 10.1016/j.jpeds.2021.11.025
DO - 10.1016/j.jpeds.2021.11.025
M3 - Article
C2 - 34798078
AN - SCOPUS:85122516869
SN - 0022-3476
VL - 242
SP - 159
EP - 165
JO - Journal of Pediatrics
JF - Journal of Pediatrics
ER -