Acute kidney injury in infants with necrotising enterocolitis: A case-control study.

Dermot Wildes, Brian Patrick Cleary, Ciara Terry, Atif Awan, Daniel O'Reilly, Michael A Boyle

Abstract read

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Article in European journal of pediatrics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

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1citing papers in PubMed

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1 · What the graph read from it

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3 · Its place in the literature

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1 citing paper in PubMed.

Sepsis in neonates with necrotizing enterocolitis: outcomes and predictive model.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2026
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5 · Who and what money

Authors and funding

6 authors.

Dermot WildesDepartment of Paediatrics, RCSI University of Medicine & Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland. dermotwildes@rcsi.com.ORCID http://orcid.org/0000-0001-6281-5713

Brian Patrick ClearyDepartment of Neonatology, Rotunda Hospital, Parnell Square, Dublin 1, Ireland.

Ciara TerryDepartment of Paediatrics, RCSI University of Medicine & Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland.

Atif AwanDepartment of Paediatrics, RCSI University of Medicine & Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland.

Daniel O'Reilly *Department of Neonatology, Rotunda Hospital, Parnell Square, Dublin 1, Ireland.

Michael A Boyle *Department of Paediatrics, RCSI University of Medicine & Health Sciences, 123 St. Stephen's Green, Dublin 2, Ireland.

Funding

Health Research Board 203930/B/16/ZIrish Research Council GOIPG 2024/3145

6 · The paper itself

Abstract

Necrotising enterocolitis (NEC) is a leading cause of morbidity and mortality in preterm infants. Acute kidney injury (AKI) is increasingly recognised as a common complication in this population, yet its relationship with NEC remains under-characterised. We sought to evaluate the incidence of AKI in infants with NEC and examine its association with NEC severity (using Bell staging) in a tertiary neonatal intensive care unit (NICU).

methodsA retrospective 1:2 case-control study was conducted in a single tertiary NICU between October 2018 and October 2023. Forty-nine preterm infants diagnosed with NEC were matched to 100 controls based on birth weight, gestational age, and gender. AKI was defined using modified neonatal KDIGO criteria, incorporating both serum creatinine and urine output.

resultsAKI was identified in 25 of 149 infants (16.8%), with an incidence among those with NEC of 30.6% compared to controls (10%). NEC exposure was associated with increased odds of AKI in our cohort when controlling for patent ductus arteriosus (PDA), birth weight, gentamicin and ibuprofen receipt, with an adjusted odds ratio (OR) of 3.6 (95% CI 1.3-10.2, p = 0.0129). Among NEC cases, AKI onset occurred a median of two days after diagnosis. No association was found between Bell stage and AKI incidence, albeit with a small sample size. Mortality in the NEC-AKI group was 60%, compared to 20.6% in NEC infants without AKI.

conclusionsNEC is associated with increased risk of AKI in preterm infants, when controlling for birth weight, gestational age PDA, ibuprofen and gentamicin exposure. Bell stage was not associated with AKI incidence, in our cohort. These findings support the consideration of early kidney function surveillance in NEC to inform risk stratification and improve outcomes. WHAT IS KNOWN: • NEC is a leading cause of morbidity in preterm infants, often triggering systemic inflammation and multiorgan dysfunction. AKI is common in neonates and associated with poor outcomes, but its relationship with NEC is not well defined. What is New: • In our cohort, NEC is associated with increased risk of AKI in preterm infants, when controlling for birth weight, gestational age, PDA, ibuprofen, and gentamicin exposure. NEC-associated AKI is linked to higher mortality. Consideration for routine surveillance for AKI in infants with NEC warrants further study.

Indexed as

Acute Kidney InjuryEnterocolitis, NecrotizingInfant, Premature, DiseasesCase-Control StudiesFemaleHumansIncidenceInfant, NewbornInfant, PrematureIntensive Care Units, NeonatalMaleRetrospective StudiesRisk FactorsSeverity of Illness IndexNecrotising enterocolitisNeonatal acute kidney injuryNeonatal intensive careNeonatology

Identifiers

PMID41083819

DOI10.1007/s00431-025-06530-w

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