Prevalence of acute kidney injury and nephrotoxic drug exposure in premature and low birth weight neonates admitted to intensive care units at Muhimbili National Hospital, Dar es Salaam

Abstract

BACKGROUND: Acute kidney injury (AKI) poses a significant threat to premature and low birth weight (LBW) neonates in neonatal intensive care units (NICUs), driven by immature renal function and frequent exposure to nephrotoxic medications. Understanding its prevalence and risk factors is critical for improving outcomes in vulnerable populations. OBJECTIVE: To determine the prevalence of AKI, exposure to potential nephrotoxic drugs and identify associated risk factors, among premature and LBW neonates admitted to NICUs at Muhimbili National Hospital (MNH), Dar es Salaam, Tanzania. METHODS: A cross-sectional study was conducted from February to June 2024 at MNH Upanga and Mloganzila, enrolling 144 premature and LBW neonates via non-probability consecutive sampling. Serum creatinine levels were measured at admission, 48 h, and day seven or pre-discharge to diagnose AKI using KDIGO criteria. Data were analyzed with SPSS v26.0, employing chi-square tests for associations and robust Poisson regression for risk factor identification (p < 0.20 for univariable inclusion, p < 0.05 for significance). RESULTS: Among 144 neonates (61.8% female, median age 5 days [IQR 3-12]), 65.3% received nephrotoxic drugs, primarily ampicillin-cloxacillin (58.3%) and gentamicin (54.9%). AKI was diagnosed in 26.4% of neonates, with 18.8% in stage 1, 6.3% in stage 2, and 1.4% in stage 3. Multivariable analysis identified male sex (aPR = 1.68, 95% CI: 1.01-2.89, p = 0.049) and exposure to two nephrotoxic drugs (aPR = 2.58, 95% CI: 1.20-5.55, p = 0.015) as independent risk factors for AKI. CONCLUSION: AKI affects over a quarter of premature and LBW neonates in NICUs, with male sex and multiple nephrotoxic drug exposures as key risk factors. Implementing routine renal monitoring and optimizing pharmacotherapy are essential to reduce AKI incidence and improve neonatal outcomes in resource-constrained settings.