![]() ![]() ![]() 10 SAS v 9.4 (SAS Institute, Cary, North Carolina) was used for all analyses. Data were compared across 3 eras (pre-NINJA, initiation, sustainability) and were reported in statistical control charts using aggregate monthly data based on 5 previously established metrics for high nephrotoxic-AKI by the NINJA collaborative. All admitted infants who met exposure criteria were included except those with end-stage kidney disease who were receiving dialysis. This prospective QI initiative project occurred at the Children’s of Alabama 48-bed level IV NICU. To advance our understanding, prevent nephrotoxic medication exposure, and improve AKI surveillance in the NICU, we performed and reported on a 24-month quality improvement (QI) project in a level IV (nondelivery) NICU entitled “Baby NINJA.” Our hypothesis is that improved screening and stewardship of nephrotoxic medication exposures will reduce AKI in the NICU setting. With lack of treatment options in a population at higher risk of CKD, AKI prevention programs focused on reducing neonatal and infantile AKI have the potential for profound impact. ![]() Presently, no medicines exist for treatment of AKI in the NICU, and when AKI occurs, acute dialysis may not be feasible in very low birth weight infants (<1500 g). NINJA demonstrated consistent reductions in nephrotoxic medication exposure and nephrotoxic-AKI in the non-critically ill pediatric population, suggesting that stewardship of nephrotoxic medication exposure can reduce AKI, but its implementation and reduction of AKI in the intensive care setting has yet to be determined. AKI during times of postnatal glomeruli growth and maturation may have detrimental effects on the long-term nephron development and risk of subsequent chronic kidney disease (CKD). 4, 5 Because neonatal nephrogenesis is not complete until 36 weeks postgestational age, many patients in the NICU have an incomplete complement of mature nephrons and glomeruli compared with their full-term counterparts. 3 About one-quarter of infants admitted to a NICU will develop at least 1 episode of AKI, and neonatal AKI is independently associated with increased mortality and prolonged length of stay. 2Įxposure to nephrotoxic medications in neonates admitted to the neonatal intensive care unit (NICU) is even higher, with up to 87% of very low birth weight (VLBW) infants exposed to at least 1 nephrotoxic medication during hospitalization. In its 2016 single-center sustainability report of noncritically ill hospitalized patients (mean age 8.7 years), the group reported a reduction of nephrotoxic medication exposure rate by 38% and the rate of incidence of AKI by 64%. 1 Nephrotoxic Injury Negated by Just-in-Time Action (NINJA) is a multicenter, quality improvement collaborative whose aim is to reduce nephrotoxic medication exposure and related AKI in the non-intensive care (ICU) setting. Approximately 30% of hospitalized noncritically ill children exposed to nephrotoxic medications develop AKI, and those who receive 3 or more concomitant nephrotoxins or are recipient of prolonged intravenous aminoglycoside antibiotics are at increased risk. Nephrotoxic medication-induced acute kidney injury (nephrotoxic-AKI) is a common and underdiagnosed morbidity in the hospitalized pediatric population.
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