ArticleFrontiers in nephrology2026
Renal resistive index and neonatal sequential organ failure assessment score as acute kidney injury risk predictors in preterm neonates with late-onset neonatal sepsis.
Article in Frontiers in nephrology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Aim: Neonatal acute kidney injury (AKI) is an independent predictor of mortality with serum creatinine (sCr) remaining the gold standard. However, by the time sCr increases, the kidney may already have lost part of its function. Late-onset neonatal sepsis (LONS) is a common trigger of AKI through inflammation and renal hypoperfusion. The renal resistive index (RRI) is a Doppler-derived marker of renal perfusion, and the neonatal sequential organ failure assessment (nSOFA) score reflects systemic organ dysfunction that may accompany sepsis-associated AKI. This study aimed to compare the diagnostic performance of the RRI and nSOFA scores for predicting AKI risk in preterm neonates with probable LONS, using the STARZ (Sethi Tibrewal Agarwal Raina waZir) score for risk stratification. Methods: This is a single-center prospective study that observed all neonates admitted to the neonatal intensive care unit (NICU) with probable LONS from July to August 2025 defined using the sepsis prediction score. Clinical and laboratory data included the STARZ score, RRI, and the nSOFA score, which were obtained at birth and a few times after the diagnosis of probable LONS based on the sepsis prediction score. Results: A total of 36 preterm neonates were included. Median RRI and STARZ scores increased during the course of LONS, while nSOFA scores significantly differed between high- and low-risk AKI groups on multiple time points. Birth weight <1, 357 g and congenital heart disease were significant risk factors. Receiver operating characteristic (ROC) analysis showed birth weight <1, 357 g [area under the curve (AUC), 0.708; sensitivity, 72.22%; and specificity, 77.78% ( Conclusions: Serial nSOFA monitoring in preterm neonates with LONS may provide practical and accessible risk stratification for AKI and could support earlier identification of infants at high risk.
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