Acute kidney injury in neonates after plasty of the aortic arch

Abstract

The purpose of study was to hold the single-center study of the incidence of acute kidney injury (AKI) in newborns that underwent surgical correction of the aortic arch pathology and make the prospective analysis of the effect of AKI on postoperative course and mortality in this category of patients.

Material and methods. From 07.01.2015 to 12.15.2015, 120 newborns with congenital heart diseases had undergone cardiac surgery in the Ukrainian Children Cardiac Center. Among them, 25 patients had pathology of the aortic arch. Of these, 8 (32%) newborns had isolated coarctation of the aorta, and 17 (68%) patients had a combination of coarctation of the aorta with other congenital heart defects. Based on the change in serum creatinine level, we studied the incidence of AKI, risk factors and complications that possibly may emerge due to its occurrence.

Results and discussion. According to our data, the AKI has emerged in 53% (n=63) of newborns that underwent the cardiac surgery. Meanwhile patients with pathology of the aortic arch showed up with the acute kidney injury in 80% (n=20) cases. The incidence of AKI in newborns, in whom the aortic arch was corrected without the use of cardiopulmonary bypass, was 72% (n=13). At the same time among the patients that underwent the cardiac surgery with cardiopulmonaru bypass, AKI appeared in 100% (n=7) of cases. We noted that newborns with AKI more often required inotropic support and mechanical ventilation during the preoperative stage. Also, the level of serum creatinine concentration was higher, and they often developed acute renal failure before surgery. In the postoperative period, among patients with acute renal failure, 9 (45%) had injury AKIN 1, 2 (10%) had AKIN 2 and 9 (45%) had AKIN 3. They required inotropes, prolonged mechanical ventilation and staying in intensive care. The use of aminoglycosides in the postoperative period did not have a significant impact on the emerge of AKI.

Conclusions. Newborns are at high risk of developing acute kidney injury after repair of congenital heart defects. Critical preoperative health condition and special features of surgical intervention in this pathology introduce the danger of a damaging effect on the kidneys. Throughout the study of this problem, we came to the conclusion that in the postoperative period patients with acute kidney injury require longer mechanical ventilation, inotropic support; they prolong the length of stay in the intensive care unit and, in general, the length of hospitalization, and have the high risk of death.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee (LEC) of institution. The informed consent of the patient was obtained for conducting the studies.