Incidence and risk factors of acute kidney injury in term neonates.

Objective: To determine the incidence and risk factors of acute kidney injury in term neonates. Study Design: Prospective Observational study. Setting: Neonatal Intensive Care Unit (NICU) of National Institute of Child Health, Karachi, Pakistan. Period: October 2024 to March 2025. Methods: A total of 190 neonates suspected to have AKI and admitted to the NICU were enrolled. The development of AKI during the study or discharge from the NICU was noted. Risk factors of AKI were also evaluated. Multivariate binary logistic regression analysis was performed for the determination of risk factors associated with the development of AKI in neonates taking p<0.05 as statistically significant. Results: Among 190 term neonates, 104 (54.7%) were male, and the mean age at admission was 2.92±1.89 days. There were 72 (37.9%) neonates who developed AKI, with stage 1 in 58.3%, stage 2 in 26.4%, and stage 3 in 15.3%. Mortality was higher in the AKI group (11.1% vs. 3.4%, p=0.035). Multivariate logistic regression identified maternal diabetes (adjusted odds ratio [aOR]: 3.22), pregnancy-induced hypertension (aOR: 2.85), IUGR (aOR: 3.75), and longer NICU stay (aOR per day: 1.16) as independent risk factors for AKI. Mortality was significantly high in AKI neonates (11.1% vs. 3.4%, p=0.035). Conclusion: This study demonstrated a high incidence of AKI among term neonates, with maternal diabetes, pregnancy-induced hypertension, maternal infection, IUGR at birth, and prolonged NICU stay identified as significant and independent risk factors.