Projects

The newborn’s kidneys are immature and vulnerable to multiple perinatal insults. Acute kidney injury (AKI) occurs in 30–70% of critically ill neonates and is an important contributor to neonatal mortality and morbidity. With significant contributions made by the Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) database to neonatal nephrology, the past decade has witnessed a growing body of literature on the incidence, risk factors and outcomes of neonatal AKI.1–4 Neonates are particularly at risk for perinatal hypoperfusion injury; with redistribution of cardiac output secondary to a hypoxic–ischaemic insult, perfusion to the kidneys can be compromised, causing AKI. Fundamentally, making a prompt diagnosis of AKI in neonates is challenging as the baby’s results reflect the maternal creatinine in the first 72 h of birth and several perinatal insults that are unique to neonates can trigger AKI. Differences in the physiological parameters of kidney function across the spectrum of gestational age and birth weight add to the diagnostic complexity. Interestingly, there are considerable differences in the perception and practice of diagnosing and managing neonatal AKI among care providers such as neonatologists, paediatricians and paediatric nephrologists.5,6 The Acute Disease Quality Initiative highlights the need for strategies designed to improve AKI care processes for neonates.7