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To evaluate post-operative outcomes and white matter injury (WMI) using brain MRI at term equivalent in neonates with and without severe acute kidney injury (AKI) following surgical necrotizing enterocolitis (NEC). A retrospective cohort study comparing neonates with severe (Stage 2/3)  vs.  other (no AKI/Stage 1) AKI using KDIGO classification with multivariable models assessing this association in the context of multiple systemic comorbidities. Of 103 neonates with surgical NEC, 60 (58%) had severe AKI. Those with severe AKI had lower birth weight (BW; 715  vs.  950 g;  p  = .023), more frequently treated with indomethacin (18.3  vs.  2.4%);  p  = .014), higher CRP levels at 24 h after NEC onset (14.4 [6.4–19.8]  vs . 4.8 [1.6–13.4];  p  = .005), higher presence of cholestasis (73.3  vs.  51.2%);  p  = .023), later age of NEC onset (14  vs.  7 d);  p  = .004), longer length of bowel resected (14.9  vs.  4.3 cm);  p  = .011), longer post-operative ileus days (14  vs.  9 d);  p  &lt; .001), longer post-operative days at starting enteral feedings (15  vs . 10 d;  p  &lt; .001), longer days of attainment of full enteral feedings (75  vs . 44.5 d;  p  = .008) and longer length of stay (140.5  vs . 94 d;  p  = .028) compared to those without severe AKI. Compared to infants without AKI by serum creatinine, those with AKI had significantly more cases of white matter abnormality (WMA; 90  vs . 36.6%;  p  &lt; .001) and retinopathy of prematurity (63.9  vs.  35.3%;  p  = .017). In addition, the presence of AKI Stage 2 and 3 by serum creatinine was independently associated with higher odds of sustaining severe WMI level on an ordinal scale (OR = 6.2; 95% CI = (1.1–35.5);  p  = .041). Neonates with severe AKI following surgical NEC were more likely to experience longer post-operative morbidity and higher WMI by MRI at term.

the journal of maternal-fetal and neonatal medicine

Clinical impact of severe acute kidney injury on post-operative and brain injury outcomes in preterm infants following surgical necrotizing enterocolitis