Association of early dysnatremia with mortality in the neonatal intensive care unit: results from the AWAKEN study

the AWAKEN Study Group

doi:10.1038/s41372-021-01260-x

Association of early dysnatremia with mortality in the neonatal intensive care unit: results from the AWAKEN study

the AWAKEN Study Group

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: To determine the association of dysnatremia in the first postnatal week and risk of acute kidney injury (AKI) and mortality. Study design: A secondary analysis of 1979 neonates in the AWAKEN cohort evaluated the association of dysnatremia with (1) AKI in the first postnatal week and (2) mortality, utilizing time-varying Cox proportional hazard models. Result: Dysnatremia developed in 50.2% of the cohort and was not associated with AKI. Mortality was associated with hyponatremia (HR 2.15, 95% CI 1.07–4.31), hypernatremia (HR 4.23, 95% CI 2.07–8.65), and combined hypo/hypernatremia (HR 6.39, 95% CI 2.01–14.01). In stratified models by AKI-status, hypernatremia and hypo/hypernatremia increased risk of mortality in neonates without AKI. Conclusion: Dysnatremia within the first postnatal week was associated with increased risk of mortality. Hypernatremia and combined hypo/hypernatremia remained significantly associated with mortality in neonates without AKI. This may reflect fluid strategies kidney injury independent of creatinine and urine-output defined AKI, and/or systemic inflammation.

Original language	English (US)
Journal	Journal of Perinatology
DOIs	https://doi.org/10.1038/s41372-021-01260-x
State	Accepted/In press - 2021
Externally published	Yes

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Obstetrics and Gynecology

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10.1038/s41372-021-01260-x

Cite this

@article{8dff6e89583746368cf25919107ed9e5,

title = "Association of early dysnatremia with mortality in the neonatal intensive care unit: results from the AWAKEN study",

abstract = "Objective: To determine the association of dysnatremia in the first postnatal week and risk of acute kidney injury (AKI) and mortality. Study design: A secondary analysis of 1979 neonates in the AWAKEN cohort evaluated the association of dysnatremia with (1) AKI in the first postnatal week and (2) mortality, utilizing time-varying Cox proportional hazard models. Result: Dysnatremia developed in 50.2% of the cohort and was not associated with AKI. Mortality was associated with hyponatremia (HR 2.15, 95% CI 1.07–4.31), hypernatremia (HR 4.23, 95% CI 2.07–8.65), and combined hypo/hypernatremia (HR 6.39, 95% CI 2.01–14.01). In stratified models by AKI-status, hypernatremia and hypo/hypernatremia increased risk of mortality in neonates without AKI. Conclusion: Dysnatremia within the first postnatal week was associated with increased risk of mortality. Hypernatremia and combined hypo/hypernatremia remained significantly associated with mortality in neonates without AKI. This may reflect fluid strategies kidney injury independent of creatinine and urine-output defined AKI, and/or systemic inflammation.",

author = "{the AWAKEN Study Group} and Basalely, {Abby M.} and Russell Griffin and Gist, {Katja M.} and Ronnie Guillet and Askenazi, {David J.} and Charlton, {Jennifer R.} and Selewski, {David T.} and Mamta Fuloria and Kaskel, {Frederick J.} and Reidy, {Kimberly J.} and David Askenazi and N. Ambalavanan and Stuart Goldstein and Amy Nathan and James Greenberg and Alison Kent and Jeffrey Fletcher and Farah Sethna and Danielle Soranno and Jason Gien and Katja Gist and Mamta Fuloria and Kim Reidy and Frederick Kaskel and Natalie Uy and Mary Revenis and Sofia Perrazo and Shantanu Rastogi and George Schwartz and D{\textquoteright}Angio, {Carl T.} and Erin Rademacher and {El Samra}, Ahmed and Ayesa Mian and Juan Kupferman and Alok Bhutada and Michael Zappitelli and Pia Wintermark and Sanjay Wazir and Sidharth Sethi and Sandeep Dubey and Maroun Mhanna and Deepak Kumar and Rupesh Raina and Susan Ingraham and Arwa Nada and Elizabeth Bonachea and Richard Fine and Robert Woroniecki and Shanthy Sridhar and Ayse Ariken",

note = "Funding Information: Institutes of Health grant UL1TR001417). The AWAKEN study at The University of New Mexico was supported by the Clinical and Translational Science Center at The University of New Mexico (National Institutes of Health grant UL1TR001449) and by The University of Iowa Institute for Clinical and Translational Science (grant U54TR001356). The AWAKEN study investigators at the Canberra Hospital at the Australian National University Medical School were supported by the Canberra Hospital Private Practice Fund, and investigators at University of Virginia Children{\textquoteright}s Hospital were supported by a 100 Women Who Care Grant from the 100 Women Charitable Foundation. Funding Information: This study was supported by the NIH T32 NIDDK 5T32DK007110-46 and NIH/NCATS Einstein-Montefiore CTSA Grant UL1TR002556. Cincinnati Children{\textquoteright}s Hospital Center for Acute Care Nephrology provided funding to create and maintain the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) study Medidata Rave electronic database. The Pediatric and Infant Center for Acute Nephrology (PICAN) provided support for web meetings and for the Neonatal Kidney Collaborative (NKC) steering committee annual meeting at The University of Alabama at Birmingham (UAB). PICAN is part of the Department of Pediatrics at UAB and is funded by Children{\textquoteright}s of Alabama hospital, UAB Department of Pediatrics, UAB School of Medicine, and UAB Center for Clinical and Translational Sciences (National Publisher Copyright: {\textcopyright} 2021, The Author(s), under exclusive licence to Springer Nature America, Inc.",

year = "2021",

doi = "10.1038/s41372-021-01260-x",

language = "English (US)",

journal = "Journal of Perinatology",

issn = "0743-8346",

publisher = "Nature Publishing Group",

}

TY - JOUR

T1 - Association of early dysnatremia with mortality in the neonatal intensive care unit

T2 - results from the AWAKEN study

AU - the AWAKEN Study Group

AU - Basalely, Abby M.

AU - Griffin, Russell

AU - Gist, Katja M.

AU - Guillet, Ronnie

AU - Askenazi, David J.

AU - Charlton, Jennifer R.

AU - Selewski, David T.

AU - Fuloria, Mamta

AU - Kaskel, Frederick J.

AU - Reidy, Kimberly J.

AU - Askenazi, David

AU - Ambalavanan, N.

AU - Goldstein, Stuart

AU - Nathan, Amy

AU - Greenberg, James

AU - Kent, Alison

AU - Fletcher, Jeffrey

AU - Sethna, Farah

AU - Soranno, Danielle

AU - Gien, Jason

AU - Gist, Katja

AU - Fuloria, Mamta

AU - Reidy, Kim

AU - Kaskel, Frederick

AU - Uy, Natalie

AU - Revenis, Mary

AU - Perrazo, Sofia

AU - Rastogi, Shantanu

AU - Schwartz, George

AU - D’Angio, Carl T.

AU - Rademacher, Erin

AU - El Samra, Ahmed

AU - Mian, Ayesa

AU - Kupferman, Juan

AU - Bhutada, Alok

AU - Zappitelli, Michael

AU - Wintermark, Pia

AU - Wazir, Sanjay

AU - Sethi, Sidharth

AU - Dubey, Sandeep

AU - Mhanna, Maroun

AU - Kumar, Deepak

AU - Raina, Rupesh

AU - Ingraham, Susan

AU - Nada, Arwa

AU - Bonachea, Elizabeth

AU - Fine, Richard

AU - Woroniecki, Robert

AU - Sridhar, Shanthy

AU - Ariken, Ayse

N1 - Funding Information: Institutes of Health grant UL1TR001417). The AWAKEN study at The University of New Mexico was supported by the Clinical and Translational Science Center at The University of New Mexico (National Institutes of Health grant UL1TR001449) and by The University of Iowa Institute for Clinical and Translational Science (grant U54TR001356). The AWAKEN study investigators at the Canberra Hospital at the Australian National University Medical School were supported by the Canberra Hospital Private Practice Fund, and investigators at University of Virginia Children’s Hospital were supported by a 100 Women Who Care Grant from the 100 Women Charitable Foundation. Funding Information: This study was supported by the NIH T32 NIDDK 5T32DK007110-46 and NIH/NCATS Einstein-Montefiore CTSA Grant UL1TR002556. Cincinnati Children’s Hospital Center for Acute Care Nephrology provided funding to create and maintain the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) study Medidata Rave electronic database. The Pediatric and Infant Center for Acute Nephrology (PICAN) provided support for web meetings and for the Neonatal Kidney Collaborative (NKC) steering committee annual meeting at The University of Alabama at Birmingham (UAB). PICAN is part of the Department of Pediatrics at UAB and is funded by Children’s of Alabama hospital, UAB Department of Pediatrics, UAB School of Medicine, and UAB Center for Clinical and Translational Sciences (National Publisher Copyright: © 2021, The Author(s), under exclusive licence to Springer Nature America, Inc.

PY - 2021

Y1 - 2021

N2 - Objective: To determine the association of dysnatremia in the first postnatal week and risk of acute kidney injury (AKI) and mortality. Study design: A secondary analysis of 1979 neonates in the AWAKEN cohort evaluated the association of dysnatremia with (1) AKI in the first postnatal week and (2) mortality, utilizing time-varying Cox proportional hazard models. Result: Dysnatremia developed in 50.2% of the cohort and was not associated with AKI. Mortality was associated with hyponatremia (HR 2.15, 95% CI 1.07–4.31), hypernatremia (HR 4.23, 95% CI 2.07–8.65), and combined hypo/hypernatremia (HR 6.39, 95% CI 2.01–14.01). In stratified models by AKI-status, hypernatremia and hypo/hypernatremia increased risk of mortality in neonates without AKI. Conclusion: Dysnatremia within the first postnatal week was associated with increased risk of mortality. Hypernatremia and combined hypo/hypernatremia remained significantly associated with mortality in neonates without AKI. This may reflect fluid strategies kidney injury independent of creatinine and urine-output defined AKI, and/or systemic inflammation.

AB - Objective: To determine the association of dysnatremia in the first postnatal week and risk of acute kidney injury (AKI) and mortality. Study design: A secondary analysis of 1979 neonates in the AWAKEN cohort evaluated the association of dysnatremia with (1) AKI in the first postnatal week and (2) mortality, utilizing time-varying Cox proportional hazard models. Result: Dysnatremia developed in 50.2% of the cohort and was not associated with AKI. Mortality was associated with hyponatremia (HR 2.15, 95% CI 1.07–4.31), hypernatremia (HR 4.23, 95% CI 2.07–8.65), and combined hypo/hypernatremia (HR 6.39, 95% CI 2.01–14.01). In stratified models by AKI-status, hypernatremia and hypo/hypernatremia increased risk of mortality in neonates without AKI. Conclusion: Dysnatremia within the first postnatal week was associated with increased risk of mortality. Hypernatremia and combined hypo/hypernatremia remained significantly associated with mortality in neonates without AKI. This may reflect fluid strategies kidney injury independent of creatinine and urine-output defined AKI, and/or systemic inflammation.

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UR - http://www.scopus.com/inward/citedby.url?scp=85119602103&partnerID=8YFLogxK

U2 - 10.1038/s41372-021-01260-x

DO - 10.1038/s41372-021-01260-x

M3 - Article

AN - SCOPUS:85119602103

JO - Journal of Perinatology

JF - Journal of Perinatology

SN - 0743-8346

ER -

Association of early dysnatremia with mortality in the neonatal intensive care unit: results from the AWAKEN study

Abstract

ASJC Scopus subject areas

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