Acute kidney injury among preterm infants receiving non-steroidal anti-inflammatory drugs for patent ductus arteriosus
Bibliographic record
Abstract
Abstract Background: Nonsteroidal anti-inflammatory drugs (NSAID) are a frequently prescribed class of medication in the neonatal intensive care unit (NICU). Hospitalized patients receiving NSAID therapy are at an increased risk of acute kidney injury (AKI). Our primary objective was to reveal AKI epidemiology in NSAID-exposed premature infants admitted to the NICU using a standardized definition.Methods: This retrospective study included infants born at ≤34 weeks gestational age who received NSAID for intraventricular haemorrhage prophylaxis [“prophylaxis group”] or symptomatic treatment for patent ductus arteriosus (PDA) [“treatment group”] between January and December 2014 at British Columbia Women’s Hospital NICU. All available serum creatinine (SCr) and 12-hour urine output (UO) were recorded from admission till day 7 post NSAID exposure. AKI incidence was determined using the modified Kidney Disease: Improving Global Outcomes (KDIGO) classification with an increase in SCr (ΔSCr) (50% rise from prior SCr within 7 days or 26.5 mmol/L rise within 48 hours) and/or UO < 1 mL/kg/hour, excluding the first 24 h of life.Results: We identified 70 eligible subjects, 32 of whom received prophylactic NSAID (prophylaxis group), and 38 received indomethacin or ibuprofen for treatment of symptomatic PDA (treatment group), with an overall AKI incidence of 23% (16/70). The treatment group had a higher proportion of infants with SCr monitoring during the NSAID than the prophylaxis group (87% vs. 13%, p<0.001). Based upon the above defined criteria (fulfilling at least one—either the UO or SCr monitoring criteria), the prophylaxis group had a significantly lower AKI rate compared with the treatment group (9% vs. 34%; p=0.014). Conclusions: AKI incidence is higher in infants treated with NSAID for symptomatic PDA than in those treated prophylactically during the first day of life, based on the criteria applied. However, the burden of AKI may be underestimated in the prophylaxis group due to fewer available SCr values after exposure, and inability to utilize UO criteria in the 1st 24 hours of life. Standardized protocols for monitoring daily SCr and UO after exposure should be implemented for all neonates with NSAID exposure and should be considered to improve AKI recognition.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".