Neonatal acute kidney injury: a survey of practices in Canadian neonatal intensive care units

OBJECTIVE: To assess current practices in the diagnosis, monitoring, and follow-up of neonatal AKI across Canadian tertiary neonatal units. STUDY DESIGN: A seven-item electronic survey was distributed to members of the Canadian Neonatal Network between December 2023 and January 2024. RESULTS: Of the 32 units contacted, 26 (81.3%) responded. On-site nephrology consultation was available at 15/26 sites (57.7%). Only 5 sites (19.2%) actively tracked AKI incidence in infants born < 33 weeks' gestation. Wide variation was observed in AKI definitions, monitoring practices, and follow-up protocols. Serum creatinine was measured prior to initiating non-steroidal anti-inflammatory drugs at 15 sites (57.7%), and 11 sites (42.3%) monitored creatinine when urine output fell below 0.5 mL/kg/hour. CONCLUSIONS: Substantial variability exists in the identification and monitoring of neonatal AKI among Canadian NICUs. Standardized diagnostic criteria and follow-up strategies are needed to improve early detection and optimize long-term renal outcomes.