Management of Acute Kidney Injury in Neonates

Initial Assessment and Management

The American Academy of Pediatrics recommends using isotonic crystalloids rather than colloids for initial management of intravascular volume expansion in neonates at risk for or with AKI, unless there is hemorrhagic shock 1, 3
The American College of Cardiology suggests implementing vasopressors in conjunction with fluids in neonates with vasomotor shock who have or are at risk for AKI 1, 4
The Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend utilizing protocol-based management of hemodynamic and oxygenation parameters to prevent development or worsening of AKI in high-risk neonates 1, 4

The American Academy of Pediatrics recommends administering a single dose of theophylline to neonates with severe perinatal asphyxia who are at high risk of AKI - this improves fluid control and GFR in the first week of life 1, 5
The National Kidney Foundation suggests avoiding using diuretics to prevent AKI, but they may be used for management of volume overload in established AKI 1, 5
The American Society of Nephrology recommends avoiding low-dose dopamine, fenoldopam, or atrial natriuretic peptide (ANP) to prevent or treat neonatal AKI 1, 6

The European Society of Pediatric Nephrology recommends providing nutrition preferentially via the enteral route when possible 1, 4
The American Academy of Pediatrics suggests ensuring adequate protein intake: 2-3 g/kg/d for infants aged 0-2 years with AKI 5
The National Kidney Foundation recommends not restricting protein intake with the aim of preventing or delaying initiation of renal replacement therapy 1, 5
The Kidney Disease Improving Global Outcomes (KDIGO) guidelines suggest targeting total energy intake of 20-30 kcal/kg/d in neonates with any stage of AKI 1, 4

The American Society of Health-System Pharmacists recommends avoiding aminoglycosides for treatment of infections unless no suitable, less nephrotoxic alternatives are available 1, 5
The National Kidney Foundation suggests administering aminoglycosides as a single daily dose rather than multiple-dose daily regimens if they must be used 1, 3
The American College of Clinical Pharmacy recommends monitoring aminoglycoside drug levels when treatment with multiple daily dosing is used for more than 24 hours, or when single-daily dosing is used for more than 48 hours 1, 3
The Infectious Diseases Society of America recommends using topical or local applications of aminoglycosides rather than intravenous administration when feasible 1, 5
The American Society of Health-System Pharmacists suggests using lipid formulations of amphotericin B rather than conventional formulations if antifungal therapy is required 1, 5

The Kidney Disease Improving Global Outcomes (KDIGO) guidelines recommend avoiding overzealous fluid resuscitation in certain conditions as it may worsen outcomes 4
The American Society of Nephrology suggests being cautious with hyperchloremic solutions (normal saline) as they can induce metabolic acidosis; consider balanced electrolyte solutions when appropriate 3, 7
The American Academy of Pediatrics recommends remembering that while theophylline may improve renal function in asphyxiated neonates, it does not affect mortality outcomes 5