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1472: RISK FACTORS ASSOCIATED WITH ACUTE KIDNEY INJURY AFTER BEDSIDE OPEN LAPAROTOMY IN NEONATES

Learning Objectives: Bedside surgeries in the neonatal intensive care unit (NICU) are encountered at times, due to increased numbers of the most vulnerable and critical infants. These infants would be at a greater risk of adverse postoperative outcomes. This study aimed to evaluate the potential risk factors associated with acute kidney injury (AKI) in infants who underwent bedside open laparotomy in the neonatal intensive care unit and analyze the association between postoperative AKI and postoperative outcomes. Methods: Retrospective data (including neonatal characteristics, perioperative findings including vital signs and fluid status, postoperative acute kidney injury incidence, and postoperative mortality rate of infants who underwent bedside open laparotomy surgery in the NICU of Seoul St. Mary’s Hospital from May 2013 to February 2017 were collected and analyzed. Results: A total of 38 cases (16 in AKI group vs 22 in no-AKI group) were analyzed. In univariable analyses, various factors were associated with the development of postoperative acute kidney injury. In multivariable logistic regression analysis, surgery duration (odds ratio=1.027, 95% confidence interval=1.009 – 1.046, p=0.004) and cumulative percentage of fluid overload (%FO) during 48 h before surgery (odds ratio=1.236, 95% confidence interval=1.029 – 1.486, p=0.024) were significant factors. Postoperative mortality rate at 30 days after surgery was significantly higher in the AKI group. Conclusions: In conclusion, the incidence of postoperative AKI in the infants who underwent bedside open laparotomy in our NICU is possibly due to the critically ill characteristics of the vulnerable infants. Surgery duration and possibly %FO before surgery are potential risk factors associated with the development of postoperative AKI. Therefore, presurgical stabilization, decreasing surgery duration, and meticulous fluid management before surgery would have key roles in preventing postoperative AKI, which, in the long run, may lead to a decrease in mortality.