Acute Kidney Injury Among Neonates With Sepsis: Incidence, Predictors and Early Mortality at Hoima Regional Referral Hospital

Abstract Background Sepsis is a potentially fatal condition frequently complicated by multi-organ dysfunction, with the kidney being among the most vulnerable organs. Neonatal acute kidney injury (AKI) contributes to prolonged hospitalization and increased mortality. Despite evidence from other countries, data on AKI in neonatal sepsis are scarce in Uganda. This study determined the incidence, Predictors, and early mortality associated with AKI among neonates with sepsis admitted at Hoima Regional Referral Hospital (HRRH). Methods This was a hospital-based prospective study conducted in the neonatal intensive care unit (NICU) of HRRH. All neonates with clinical or culture-confirmed sepsis whose caregivers consented were enrolled consecutively. AKI was diagnosed using the modified Kidney Disease Improving Global Outcomes (KDIGO) criteria. Serum creatinine levels and urine output were monitored, and participants were followed for 7 days to determine early mortality. Data were analyzed using SPSS version 25. Modified Poisson regression was used to identify independent Predictors, with significance set at p < 0.05. Results A total of 106 neonates were enrolled, of whom 58.5% were female and 82.1% presented within the first 72 hours of life. The incidence of AKI was 20.8% (22/106) . Independent Predictors for AKI included maternal fever in the week preceding delivery ( p = 0.004), neonatal convulsions ( p = 0.011), shock ( p = 0.002), failure to pass urine in the previous 24 hours ( p = 0.001), and low birth weight <1.5 kg ( p = 0.016). The early mortality rate was significantly higher among neonates with AKI (31.8%) compared to those without AKI (2.4%) ( p < 0.001). Conclusion AKI is common among neonates with sepsis, occurring in one in every five cases, and is associated with markedly increased mortality. Early identification and management of at-risk neonates—especially those with maternal fever, low birth weight, or shock—are crucial. Strengthening antenatal infection control and neonatal renal monitoring is recommended.