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Background <p>The current criteria modified from Kidney Disease Improving Global Outcomes (KDIGO) for neonatal AKI (acute kidney injury) underestimate its prevalence. We aim to propose complementary AKI (cAKI) criteria for neonatal AKI using serum creatinine (SCr) reference limits to enhance AKI diagnosis.</p> Methods <p>Neonatal SCr references were established using data from 2007 to 2024. We propose that neonates with SCr level ≥ 1.5 times the upper limit of SCr reference should also be diagnosed with AKI. The incidence and two-year mortality of neonatal AKI according to KDIGO SCr criteria and our cAKI criteria were compared among neonates admitted to intensive care units.</p> Results <p>The overall incidence of neonatal AKI by KDIGO SCr criteria is 20.2%, with an additional 4.6% identified by our cAKI criteria. Furthermore, neonates diagnosed with AKI according to our cAKI criteria had significantly higher 2-year mortality rates than undiagnosed neonates in all gestational age groups (this difference was borderline significant for extremely preterm neonates), whereas neonates diagnosed with AKI according to the KDIGO SCr criteria had significantly higher 2-year mortality rates than undiagnosed neonates only in term and late/moderately preterm groups.</p> Conclusions <p>This study is the first to propose modified neonatal AKI criteria with SCr references, demonstrating a significant association with mortality in the additional cases identified.</p> Graphical abstract <p></p>

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Establishing a reference range for serum creatinine in the neonatal population and re-defining neonatal acute kidney injury

  • 期刊论文

  • 发表日期：

    2026年1月8日

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  • Gwo-Tsann Chuang,
  • I-Jung Tsai,
  • Yong-Kwei Tsau

摘要

Background

The current criteria modified from Kidney Disease Improving Global Outcomes (KDIGO) for neonatal AKI (acute kidney injury) underestimate its prevalence. We aim to propose complementary AKI (cAKI) criteria for neonatal AKI using serum creatinine (SCr) reference limits to enhance AKI diagnosis.

Methods

Neonatal SCr references were established using data from 2007 to 2024. We propose that neonates with SCr level ≥ 1.5 times the upper limit of SCr reference should also be diagnosed with AKI. The incidence and two-year mortality of neonatal AKI according to KDIGO SCr criteria and our cAKI criteria were compared among neonates admitted to intensive care units.

Results

The overall incidence of neonatal AKI by KDIGO SCr criteria is 20.2%, with an additional 4.6% identified by our cAKI criteria. Furthermore, neonates diagnosed with AKI according to our cAKI criteria had significantly higher 2-year mortality rates than undiagnosed neonates in all gestational age groups (this difference was borderline significant for extremely preterm neonates), whereas neonates diagnosed with AKI according to the KDIGO SCr criteria had significantly higher 2-year mortality rates than undiagnosed neonates only in term and late/moderately preterm groups.

Conclusions

This study is the first to propose modified neonatal AKI criteria with SCr references, demonstrating a significant association with mortality in the additional cases identified.

Graphical abstract