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:
The authors thank all the members of the Neonatal Kidney Collaborative who participated in the AWAKEN study: University of Alabama, Birmingham: David Askenazi, MD; Namasivayam Ambalavanan, MD; Russell Griffin, PhD; Cincinnati Children’s Hospital: Stuart Goldstein, MD; Amy Nathan, MD; James Greenberg, MD; Canberra Hospital: Alison Kent, MD (currently at the University of Rochester); Jeffrey Fletcher, MD; Farah Sethna, MD; Children’s Hospital of Colorado: Danielle Soranno, MD; Jason Gien, MD; Katja Gist, MD; Children’s Hospital at Montefiore/Albert Einstein: Mamta Fuloria, MD; Kim Reidy, MD; Frederick Kaskel, MD; Natalie Uy, MD; Children’s National Medical Center: Mary Revenis, MD; Sofia Perrazo, MD; Shantanu Rastogi, MD; Golisano Children’s Hospital University of Rochester: George Schwartz, MD; Carl T. D’Angio, MD; Ronnie Guillet, MD, PhD; Erin Rademacher, MD; Ahmed El Samra, MD (currently Union Hospital, Terre Haute); Ayesa Mian, MD; Maimonides Medical Center: Juan Kupferman, MD; Alok Bhutada, MD; McGill University: Michael Zappitelli, MD; Pia Wintermark, MD; Medanta, Medicity The Cradle: Sanjay Wazir, MD; Sidharth Sethi, MD; Sandeep Dubey, MD; Metrohealth Medical Center: Maroun Mhanna, MD; Deepak Kumar, MD; Rupesh Raina, MD; Nationwide Children’s Hospital: Susan Ingraham, MD; Arwa Nada, MD; Elizabeth Bonachea, MD; Stonybrook University: Richard Fine, MD; Robert Woroniecki, MD; Shanthy Sridhar, MD; Texas Children’s Hospital: Ayse Ariken, MD; Christopher Rhee, MD; Tufts Medical Center: Lawrence Milner, MD; Alexandra Smith, MD; Julie Nicoletta, MD; University of British Columbia: Cherry Mammen, MD; Avash Jeet Singh, MD; Anne Synnes, MD; University of Iowa: Jennifer Jetton, MD; Tarah Colaizy, MD; Jonathan Klein, MD; Patrick Brophy (currently University of Rochester); University of Kentucky: Aftab Chishti, MD; Mina Hanna, MD; University of Miami: Carolyn Abitbol, MD; Marissa Defreitas, MD; Shahnaz Duara, MD; Salih Yasin, MD; University of Michigan: David Selewski, MD (currently Medical University of South Carolina); Subrata Sarker, MD; University of New Mexico: Craig Wong, MD; A. Staples, MD; Robin Ohls, MD; Catherine Joseph, MD (currently Texas Children’s Hospital); Tara Dupont, MD (currently University of Utah); University of Virginia: Jennifer Charlton, MD; Jonathan R. Swanson, MD; Matthew Harer (currently University of Wisconsin); Patricio Ray, MD; University of Washington: Sangeeta Hingorani, MD; Christine Hu, MD; Sandra Juul, MD.
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 - 2022/10
Y1 - 2022/10
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.
UR - http://www.scopus.com/inward/record.url?scp=85119602103&partnerID=8YFLogxK
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
C2 - 34775486
AN - SCOPUS:85119602103
SN - 0743-8346
VL - 42
SP - 1353
EP - 1360
JO - Journal of Perinatology
JF - Journal of Perinatology
IS - 10
ER -