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- Title
Kidney Health Monitoring in Neonatal Intensive Care Unit Graduates: A Modified Delphi Consensus Statement.
- Authors
Starr, Michelle C.; Harer, Matthew W.; Steflik, Heidi J.; Gorga, Stephen; Ambalavanan, Namasivayam; Beck, Tara M.; Chaudhry, Paulomi M.; Chmielewski, Jennifer L.; Defreitas, Marissa J.; Fuhrman, Dana Y.; Hanna, Mina; Joseph, Catherine; Kwiatkowski, David M.; Krawczeski, Catherine D.; Liberio, Brianna M.; Menon, Shina; Mohamed, Tahagod H.; Rumpel, Jennifer A.; Sanderson, Keia R.; Schuh, Meredith P.
- Abstract
Key Points: Question: What are the (1) recommendations for follow-up after discharge from a neonatal intensive care unit among infants at risk of chronic kidney disease and (2) research priorities for improving kidney health of at-risk formerly critically ill infants? Findings: In this modified Delphi consensus statement, a panel of 51 neonatal nephrology experts developed 10 consensus recommendations regarding the follow-up of infants at risk of chronic kidney disease during childhood. The panel identified critical gaps in knowledge and determined research priorities. Meaning: Specific subpopulations of infants, including those born preterm, with acute kidney injury, and with critical cardiac disease, discharged from the neonatal intensive care unit are at increased risk for developing chronic kidney disease during childhood; key recommendations include risk assessment at time of hospital discharge, clinician and family education, and risk-stratified longitudinal follow-up. This consensus study presents recommendations from a 51-member working group regarding kidney follow-up care for infants discharged from the neonatal intensive care unit. Importance: Kidney disease is common in infants admitted to the neonatal intensive care unit (NICU). Despite the risk of chronic kidney disease (CKD) in infants discharged from the NICU, neither evidence- nor expert-based recommendations exist to guide clinical care after discharge. Objective: To develop recommendations for risk stratification and kidney health monitoring among infants after discharge from the NICU. Evidence Review: At the National Institute of Health–supported Consensus Workshop to Address Kidney Health in Neonatal Intensive Care Unit Graduates meeting conducted in February 2024, a panel of 51 neonatal nephrology experts focused on 3 at-risk groups: (1) preterm infants, (2) critically ill infants with acute kidney injury (AKI), and (3) infants with critical cardiac disease. Using established modified Delphi processes, workgroups derived consensus recommendations. Findings: In this modified Delphi consensus statement, the panel developed 10 consensus recommendations, identified gaps in knowledge, and prioritized areas of future research. Principal suggestions include risk stratification at time of hospital discharge, family and clinician education and counseling for subsequent kidney health follow-up, and blood pressure assessment as part of outpatient care. Conclusions and Relevance: Preterm infants, critically ill infants with AKI, and infants with critical cardiac disease are at increased risk of CKD. We recommend (1) risk assessment at the time of discharge, (2) clinician and family education, and (3) kidney health assessments based on the degree of risk. Future work should focus on improved risk stratification, identification of early kidney dysfunction, and development of interventions to improve long-term kidney health.
- Subjects
CONSENSUS (Social sciences); NEONATAL intensive care units; NEONATAL intensive care; DELPHI method
- Publication
JAMA Network Open, 2024, Vol 7, Issue 9, pe2435043
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.35043