Acute kidney injury (AKI) is classified based on prerenal, intrinsic, and postrenal causes. In the newborn, AKI can occur after an insult during the prenatal, perinatal, or postnatal period. AKI is usually an underrecognized condition and its true incidence is unknown. AKI may result from the administration of a number of different nephrotoxic medications, which are often used concurrently in critically ill neonates, exponentially increasing the risk of renal injury. Drug toxicity may also compromise the formation and development of nephrons, and this is particularly important in preterm infants, who have incomplete nephrogenesis. Little is known about the pharmacokinetics and pharmacodynamics of different medications used in neonates, especially for the most immature infant, and the use of most medications in this population is off label. Strategies to prevent AKI include the avoidance of hypotension, hypovolemia, fluid imbalances, hypoxia, and sepsis as well as judicious use of nephrotoxic medications. Treatment strategies aim to maintain fluids and electrolytic and acid-base homeostasis, along with an adequate nutritional status. Neonates are especially prone to long-term sequelae of AKI and benefit from long-term follow-up. This review summarizes the most relevant aspects of nephrotoxicity in neonates and describes the prevention, treatment, and follow-up of AKI in neonates.
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http://dx.doi.org/10.1542/neo.22-8-e506 | DOI Listing |
J Antimicrob Chemother
November 2024
Infection Management and Prevention Service, The Queensland Children's Hospital, Brisbane, Queensland 4101, Australia.
Children (Basel)
October 2024
Department of Pharmacy, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan.
Chronic kidney disease (CKD) is a widespread condition often resulting from multiple factors, including maternal influences. These risk factors not only heighten the likelihood of developing CKD but increase the risk of a preterm birth. Adverse events during nephrogenesis can disrupt kidney development, leading to a reduced number of nephrons.
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October 2024
Department of Pediatrics, Pediatric Infectious Diseases, Specialized Pediatric Service, Cliniques Universitaires Saint-Luc, Brussels, Belgium.
CEN Case Rep
October 2024
Department of Pediatric Surgery, School of Medicine, Iwate Medical University, 2-1-1, Idaidori, Yahaba-Cho, Shiwa-Gun, Iwate Prefecture, 028-3694, Japan.
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