Paulomi M. Chaudhry

Introduction: Emerging evidence suggests that an impaired foetal environment—defined as maternal factors such as hypertensive disorders and diabetes—might contribute to outcomes in neonates with CHD. With this multicentre study, we prospectively collected data regarding impaired foetal environment to assess the impact on mortality in two ventricle and single ventricle neonates with CHD. Materials and methods: A module of prospectively collected maternal-foetal environment data was linked to established Pediatric Cardiac Critical Care Consortium data from June 2019 to July 2020. All neonates undergoing cardiothoracic surgery were included in this study. The outcome was in-hospital mortality. The primary predictor was the degree of impaired foetal environment defined as none, mild, or significant based on the presence of maternal hypertensive and glucose homeostasis disorders. Results: There were a total of 1913 neonates included in this study from 26 different centres. 218 patients had at least 1 missing impaired foetal environment data field (11.8%). Impaired foetal environment was not associated with increased mortality; however, there was a strong trend in the preterm single ventricular population. Discussion: While the overall cohort did not demonstrate a statistically significant relationship between impaired foetal environment and mortality, a notable trend emerged among preterm infants with single-ventricle physiology, suggesting increased mortality associated with more severe impaired foetal environment. The absence of statistical significance in this subgroup is likely attributable to the limited sample size and the substantial proportion of missing data highlighting the challenges of the mother-baby dyad in data collections.

Objective: Determine prenatal and neonatal factors that predict infantile outcomes in patients with congenital heart disease (CHD). Study Design: Retrospective cohort of 415 neonates with CHD admitted to a neonatal intensive care unit (NICU). Statistical tests included Chi-square, Fisher’s Exact, Kruskal-Wallis, and multivariable logistic regression. Results: Cardiac lesion type was associated with mortality, length of stay, and enteral feeding tube support at discharge (EFTD) ( p ≤ 0.01). A genetic diagnosis and an extra-cardiac congenital anomaly were associated with higher odds of respiratory support needs at discharge (RSND) [OR 2.8 (95% CI: 1.2, 6.5); 4.8 (1.9, 11.8)] and EFTD [5.5 (2.9, 10.8); 3.4 (2.4–9.7)]. Lower birth weight was associated with higher odds of RSND [0.5 (0.38, 0.66)], and lower gestational age with higher odds of EFTD [0.84 (0.75, 0.95)]. Conclusion: Several factors predicted adverse outcomes in infants with CHD, helping to identify high-risk cases for targeted care and improved parental guidance.

Acute kidney injury is common among neonates with critical cardiac disease. Risk factors and associations with kidney‐related outcomes are heterogeneous and distinct from other neonates. As survival of children with critical cardiac disease increases to adulthood, the burden of chronic kidney disease is increasing. Thirty percent to 50% of adults with congenital heart disease have impaired kidney function, even in the absence of prior kidney injury episodes. This may be related to the current standardized acute kidney injury criteria, which may not fully capture clinically meaningful kidney injury and long‐term kidney health risks. An improved understanding of which neonates with critical cardiac disease should undergo kidney health follow‐up is imperative. During the National Institutes of Health–supported Neonatal Kidney Health Consensus Workshop to Address Kidney Health meeting conducted in February 2024, a panel of 51 neonatal nephrology experts focused on at‐risk groups: (1) preterm infants, (2) critically ill infants with acute kidney injury, and (3) infants with critical cardiac disease. The critical cardiac disease subgroup, comprising multidisciplinary experts, used a modified Delphi process to achieve consensus on recommendations for kidney health follow‐up. In this report, we review available data on kidney health follow‐up in critical cardiac disease and summarize the 2 consensus‐based recommendations. We introduce novel diagnostic and risk‐stratification tools for acute kidney injury diagnosis in neonates with cardiac disease to guide follow‐up recommendations. Finally, we identify important knowledge gaps, representing areas of focus for future research. These should be prioritized to understand and improve long‐term kidney health in critical cardiac disease.

Objective To investigate whether NICU discharge summaries documented neonatal AKI and estimate if nephrology consultation mediated this association. Study design Secondary analysis of AWAKEN multicenter retrospective cohort. Exposures: AKI severity and diagnostic criteria. Outcome: AKI documentation on NICU discharge summaries using multivariable logistic regression to estimate associations and test for causal mediation. Results Among 605 neonates with AKI, 13% had documented AKI. Those with documented AKI were more likely to have severe AKI (70.5% vs. 51%, p < 0.001) and SCr-only AKI (76.9% vs. 50.1%, p = 0.04). Nephrology consultation mediated 78.0% (95% CL 46.5–109.4%) of the total effect of AKI severity and 82.8% (95% CL 70.3–95.3%) of the total effect of AKI diagnostic criteria on documentation. Conclusion We report a low prevalence of AKI documentation at NICU discharge. AKI severity and SCr-only AKI increased odds of AKI documentation. Nephrology consultation mediated the associations of AKI severity and diagnostic criteria with documentation.

Objective To describe three different standardized approaches to improving neonatal acute kidney injury (AKI) identification and the impact on AKI identification, incidence, and nephrology consultation and referral. Study design A retrospective cohort study in three academic NICUs. We compared AKI identification, AKI incidence, nephrology consultation, and nephrology follow-up before and after implantation of local protocols to standardize neonatal AKI identification. Result Neonatal AKI identification improved in all three NICUs following protocol implementation (26–85%, P < 0.0001). Each center also saw increases in nephrology consultation (15–83%, P < 0.0001) and nephrology follow-up (7–73%, P < 0.0001). AKI incidence decreased significantly (21–12%, P < 0.0001). Conclusion Multiple strategies can be successfully operationalized to improve neonatal AKI identification. While different in approach, each strategy resulted in increased AKI identification and nephrology involvement. This study emphasizes the importance of local standardized approaches to AKI to improve AKI identification and nephrology involvement in the NICU.