Wazir et al reported a score that can help to identify a neonate in the NICU who is at risk for acute kidney injury (AKI). The authors are from multiple institutions in India and Children's Hospital of Richmond.
Patient selection: neonate admitted to the neonatal intensive care unit (NICU)
Parameters:
(1) age at entry into NICU in hours
(2) positive pressure ventilation (PPV) in the delivery room
(3) gestational age in weeks
(4) sepsis during NICU stay
(5) significant cardiac disease
(6) urine output in mL per kg per hour
(7) serum creatinine in mg/dL
(8) use of nephrotoxic drugs
(9) use of furosemide
(10) use of inotropes
|
Parameter
|
Finding
|
Points
|
|
age at entry
|
< 25.5 hours
|
6
|
|
|
>= 25.5 hours
|
0
|
|
PPV in delivery room
|
no
|
0
|
|
|
yes
|
7
|
|
gestational age
|
< 28 weeks
|
7
|
|
|
>= 28 weeks
|
0
|
|
sepsis
|
no
|
0
|
|
|
yes
|
6
|
|
significant cardiac disease
|
no
|
0
|
|
|
yes
|
10
|
|
urine output
|
< 1.32 mL/kg/h
|
7
|
|
|
>= 1.32 mL/kg/h
|
0
|
|
serum creatinine
|
< 0.98
|
0
|
|
|
>= 0.98
|
20
|
|
nephrotoxic drugs
|
no
|
0
|
|
|
yes
|
11
|
|
furosemide
|
no
|
0
|
|
|
yes
|
9
|
|
inotropes
|
no
|
0
|
|
|
yes
|
17
|
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 100
• A score >= 31.5 is associated with acute kidney injury (80%).
• A score < 31.5 is low risk for acute kidney injury (4%).
Performance:
• The score has a sensitivity of 93% and specificity of 87%.
• The negative predictive value is 96%.
• The area under the ROC curve is 0.97.
