AKI during times of postnatal glomeruli growth and maturation may have detrimental effects on the long-term nephron development and risk of subsequent chronic kidney disease (CKD). 4, 5 Because neonatal nephrogenesis is not complete until 36 weeks postgestational age, many patients in the NICU have an incomplete complement of mature nephrons and glomeruli compared with their full-term counterparts. 3 About one-quarter of infants admitted to a NICU will develop at least 1 episode of AKI, and neonatal AKI is independently associated with increased mortality and prolonged length of stay. 2Įxposure to nephrotoxic medications in neonates admitted to the neonatal intensive care unit (NICU) is even higher, with up to 87% of very low birth weight (VLBW) infants exposed to at least 1 nephrotoxic medication during hospitalization. In its 2016 single-center sustainability report of noncritically ill hospitalized patients (mean age 8.7 years), the group reported a reduction of nephrotoxic medication exposure rate by 38% and the rate of incidence of AKI by 64%. 1 Nephrotoxic Injury Negated by Just-in-Time Action (NINJA) is a multicenter, quality improvement collaborative whose aim is to reduce nephrotoxic medication exposure and related AKI in the non-intensive care (ICU) setting. Approximately 30% of hospitalized noncritically ill children exposed to nephrotoxic medications develop AKI, and those who receive 3 or more concomitant nephrotoxins or are recipient of prolonged intravenous aminoglycoside antibiotics are at increased risk. Nephrotoxic medication-induced acute kidney injury (nephrotoxic-AKI) is a common and underdiagnosed morbidity in the hospitalized pediatric population.
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