Influence of fluid overload in the post-operative period in newborns on the development of acute renal injury and duration of ICU stay

Abstract

Aim. To identify the relationship between fluid overload in children who received infusion therapy in the postoperative period at surgical intensive care unit (ICU), the development of acute kidney injury (AKI), and the length of ICU stay.

Methods. A retrospective cohort observational study was conducted. Our study includes 75 newborns with malformations of the gastrointestinal tract, diaphragmatic hernias, gastroschisis, necrotizing enterocolitis and sacrococcygeal teratomas treated after surgery in the ICU. The Kidney Disease: Improving Global Outcomes (nKDIGO) scale was used to detect AKI. To assess the fluid overload, the ratio of the difference between the introduced and released liquid and entering the ICU weight was used (in %). Significant overload was adopted value more than 5%. The indicator “injected fluid” consisted of the volume of infusion and enteral nutrition. The indicator of “released fluid” included diuresis, fluid loss from the gastrointestinal tract, intestinal stomas, and drainages.

Results. The frequency of AKI was 28.0% (21 of 75). The average time of AKI development from the moment of surgical intervention was 5.9 ± 3.29 days. The duration of ICU stay after surgery was 8.0 [5.0; 16.0] days. In 18 of 75 (24%) children, the fluid overload of more than 5% was observed on the 1st postoperative day. In 12 out of 75 (16%) children, the fluid overload of more than 5% was observed on the 2^nd postoperative day. A fluid overload of more than 5%, observed on the 1^st day after the operation, was associated with a longer ICU stay. The rate of AKI is higher when a fluid overload of more than 5% on the 2^nd day after surgery was observed.

Conclusion. Severe fluid overload can be a significant factor of the AKI development. Fluid overload more then 5% on the 2^nd day after surgery may lead to an increase in the incidence of AKI. Liquid overload more then 5% on the 1^st day after surgery may lead to an increase in the length of ICU stay. In newborns, it is necessary to take into account the fluid load at the first two days after the operation and correct the infusion therapy in case of fluid overload detection.

Keywords

acute kidney injury / Risk Factors / Fluid overload / Adverse outcomes / Critically ill neonates / Intensive care / Length of ICU stay

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RIGHTS & PERMISSIONS

Zolotareva L.S., Khorev V.V., Makulova A.I., Stepanenko S.M., Zil’bert E.V., Svetlichnaya T.O.