The incidence of Acute Kidney Injury in preterm infants treated with early high dose caffeine

Abstract Background and Objectives Acute kidney injury (AKI) is common in neonates and associated with increased morbidity and mortality, longer hospitalization, and a higher risk for future kidney damage. Caffeine treatment, commonly used to treat apnea of prematurity, was reported to be associated with decreased AKI occurrence. However, previous studies lack uniformity regarding the dosage and timing of the administration of the drug. The objective of this study was to assess the incidence of AKI in VLBW preterm infants treated with early high dose caffeine, and to identify risk factors associated with AKI. Methods A retrospective cohort study of very low birth weight preterm infants admitted to the Neonatal Intensive Care Unit (NICU) at the Shaare Zedek Medical Center between Jan. 1, 2017 and Dec. 31, 2019. AKI was defined according to the neonatal AKI KDIGO classification, based on an elevation of serum creatinine levels or a decrease in urine output. High dose Caffeine (20 mg/kg bolus, administrated in the first hour of life, followed by a maintenance dose of 10 mg/kg/day) was universally administrated to all VLBW preterm infants born less than 32 weeks of gestation. Infants with inadequate data regarding urine output or less than two serum creatinine measurements were excluded. Results During the study period 311 VLBW infants were admitted, all had adequate serum creatinine and urine output data. 301 met the inclusion criteria, 41 infants (13.6%) were diagnosed with AKI, while only 12 (4%) during the first week of life, a significantly lower incidence in comparison to previous reports (p -value < 0.0001). Sixteen infants (5.1%) had more than one AKI episode. Seven infants (17%) had AKI stage 1 and 17 infants had stage 2 and 3 (41.5%). AKI was associated with lower gestational age and male sex (p value = 0.002 and 0.03, respectively). Conclusions The incidence of AKI in a cohort of VLBW infants, treated with early high dose Caffeine was significantly lower as compared to previous studies, especially in the first week of life.