Publications

  • Association of Fluid Balance With Short- and Long-term Respiratory Outcomes in Extremely Premature Neonates: A Secondary Analysis of a Randomized Clinical Trial
    • Michelle C Starr, Russell Griffin, Katja M Gist, Jeffrey L Segar, Rupesh Raina, Ronnie Guillet, Saudamini Nesargi, Shina Menon, Nekayla Anderson, David J Askenazi, David T Selewski; Neonatal Kidney Collaborative Research Committee. JAMA Netw Open. 2022 Dec 1;5(12):e2248826.
    • A total of 874 neonates (449 [51.4%] male; mean [SD] BW, 801 [188] g; 187 [21.4%] Hispanic, 676 [77.3%] non-Hispanic, and 11 [1.3%] of unknown ethnicity; 226 [25.9%] Black, 569 [65.1%] White, 51 [5.8%] of other race, and 28 [3.2%] of unknown race) were included in this analysis. Of these 874 neonates, 458 (52.4%) received mechanical ventilation on postnatal day 14, and 291 (33.3%) had severe BPD or had died. Median peak positive FB was 11% (IQR, 4%-20%), occurring on postnatal day 13 (IQR, 9-14). A total of 93 (10.6%) never decreased below their BW.
    • doi: 10.1001/jamanetworkopen.2022.48826
  • Correction to: Low albumin levels are independently associated with neonatal acute kidney injury: a report from AWAKEN Study Group.
    • Nada A, Askenazi D, Kupferman JC, Mhanna M, Mahan JD, Boohaker L, Li L, Griffin RL; AWAKEN Collaborative. Pediatr Nephrol. 2022 Jul;37(7):1699-1700.
    • Erratum for "Low albumin levels are independently associated with neonatal acute kidney injury: a report from AWAKEN Study Group" doi: 10.1007/s00467-021-05295-2. Epub 2021 Oct 18. PMID: 34657971
    • doi: 10.1007/s00467-022-05495-4
  • Documentation of acute kidney injury at discharge from the neonatal intensive care unit and role of nephrology consultation.
    • Chmielewski J, Chaudhry PM, Harer MW, Menon S, South AM, Chappell A, Griffin R, Askenazi D, Jetton J, Starr MC; Neonatal Kidney Collaborative. J Perinatol. 2022 Jul;42(7):930-936.
    • Among 605 neonates with AKI, 13% had documented AKI. Those with documented AKI were more likely to have severe AKI (70.5% vs. 51%, p < 0.001) and SCr-only AKI (76.9% vs. 50.1%, p = 0.04). Nephrology consultation mediated 78.0% (95% CL 46.5-109.4%) of the total effect of AKI severity and 82.8% (95% CL 70.3-95.3%) of the total effect of AKI diagnostic criteria on documentation.
    • doi: 10.1038/s41372-022-01424-3
  • Maternal Hypertension Disorders and Neonatal Acute Kidney Injury: Results from the AWAKEN Study
    • Marissa Janel Defreitas, Russell Griffin, Keia Sanderson, Arwa Nada, Jennifer R Charlton, Jennifer Jetton, Alison Kent, Ronnie Guillet, David Askenazi , C Abitbol. Am J Perinatol. 2022 Feb 23.
    • Neonates exposed to any maternal HTN disorder had a tendency towards less overall and early AKI. When stratified by inborn versus outborn, exposure to both maternal HTN disorders was associated with a significantly reduced odds of early AKI only in the inborn neonates. Exposure to maternal HTN, especially pre/eclampsia superimposed on chronic HTN, was associated with less likelihood of early AKI in the inborn group.
    • doi: 10.1055/a-1780-2249
  • Advances in Neonatal Acute Kidney Injury
    • Starr MC, Charlton JR, Guillet R, Reidy K, Tipple TE, Jetton JG, Kent AL, Abitbol CL, Ambalavanan N, Mhanna MJ, Askenazi DJ, Selewski DT, Harer MW; Neonatal Kidney Collaborative Board. Pediatrics. 2021 Nov;148(5):e2021051220
    • In this state-of-the-art review, we highlight the major advances over the last 5 years in neonatal acute kidney injury (AKI). Large multicenter studies reveal that neonatal AKI is common and independently associated with increased morbidity and mortality. The natural course of neonatal AKI, along with the risk factors, mitigation strategies, and the role of AKI on short- and long-term outcomes, is becoming clearer. Specific progress has been made in identifying potential preventive strategies for AKI, such as the use of caffeine in premature neonates, theophylline in neonates with hypoxic-ischemic encephalopathy, and nephrotoxic medication monitoring programs. 
    • doi: 10.1542/peds.2021-051220
  • Association of early dysnatremia with mortality in the neonatal intensive care unit: results from the AWAKEN study
    • Abby M Basalely, Russell Griffin, Katja M Gist, Ronnie Guillet, David J Askenazi, Jennifer R Charlton, David T Selewski, Mamta Fuloria, Frederick J Kaskel Kimberly J Reidy, AWAKEN Study Group. Journal of Perinatology. 2021
    • Dysnatremia developed in 50.2% of the cohort and was not associated with AKI. Mortality was associated with hyponatremia (HR 2.15, 95% CI 1.07-4.31), hypernatremia (HR 4.23, 95% CI 2.07-8.65), and combined hypo/hypernatremia (HR 6.39, 95% CI 2.01-14.01). In stratified models by AKI-status, hypernatremia and hypo/hypernatremia increased risk of mortality in neonates without AKI.
    • doi: 10.1038/s41372-021-01260-x
  • Low albumin levels are independently associated with neonatal acute kidney injury: a report from AWAKEN Study Group
    • Arwa Nada, David Askenazi, Juan C Kupferman, Maroun Mhanna, John D Mahan, Louis Boohaker, Linzi Li, Russell L Griffin. Pediatr Nephrol. 2021 Oct 18.
    • Low albumin levels were associated with increased odds of neonatal AKI; for every 0.1 g/dL decrease in albumin, the odds of late AKI increased by 12% on continuous analysis. After adjustment for potential confounders, neonates with albumin values in the lowest quartiles (< 2.2 g/dL) had an increased odds of early [Adjusted Odd Ratio (AdjOR) 2.5, 95% CI = 1.1-5.3, p < 0.03] and late AKI [AdjOR 13.4, 95% CI = 3.6-49.9, p < 0.0001] compared to those with albumin in the highest quartile (> 3.1 g/dL). Albumin levels of 2.6 g/dL and 2.4 g/dL best predicted early (AUC = 0.59) and late AKI (AUC = 0.64), respectively.
    • doi: 10.1007/s00467-021-05295-2
  • Relationship of patent ductus arteriosus management with neonatal AKI.
    • Guillet R, Selewski DT, Griffin R, Rastogi S, Askenazi DJ, D'Angio CT; Neonatal Kidney Collaborative. Journal of Perinatology volume 41, pages 1441–1447 (2021)
    • Of 526 neonates with sufficient data to diagnose AKI, 157 (30%) had PDA (61 conservative management, 62 pharmacologic treatment only, 34 surgical ligation). In analyses adjusted for sex, birthweight, gestational age, caffeine, nephrotoxin exposure, vasopressor and mechanical ventilation use, with conservative management as reference, there were no differences among treatment cohorts in the odds of AKI.
    • doi: 10.1038/s41372-021-01054-1
  • AWAKEN-Ing a New Frontier in Neonatal Nephrology
    • David Joseph Askenazi. Front Pediatr. 2020 Feb 7;8:21.
    • In 2013, literature about the epidemiology of neonatal acute kidney injury (AKI) was limited to primarily retrospective, single center studies that suggested that AKI was common and that those with AKI had higher rates of mortality. We developed a 24-center retrospective cohort of neonates admitted to the NICU between January 1 and March 31, 2014. Analysis of the Assessment of Worldwide Acute Kidney Epidemiology in Neonates (AWAKEN) cohort, has allowed us to describe the prevalence, risk factors and impact of neonatal AKI for different gestational age cohorts.
    • doi: 10.3389/fped.2020.00021
  • Low Hemoglobin Levels Are Independently Associated With Neonatal Acute Kidney Injury: A Report From the AWAKEN Study Group
    • Arwa Nada, David Askenazi, Louis J Boohaker, Linzi Li, John D Mahan, Jennifer Charlton, Russell L Griffin, AWAKEN Study Group. Pediatric Research (2020)
    • Lower Hb in the first postnatal week was associated with late AKI, though the association no longer remained after fluid balance was included. Minimum Hb in the first postnatal week was significantly lower in neonates with AKI after the first postnatal week (late AKI). After controlling for multiple potential confounders, compared to neonates with a minimum Hb ≥17.0 g/dL, both those with minimum Hb ≤12.6 and 12.7-14.8 g/dL had an adjusted increased odds of late AKI (aOR 3.16, 95% CI 1.44-6.96, p = 0.04) and (aOR 2.03, 95% CI 1.05-3.93; p = 0.04), respectively. This association was no longer evident after controlling for fluid balance. The ability of minimum Hb to predict late AKI was moderate (c-statistic 0.68, 95% CI 0.64-0.72) with a sensitivity of 65.9%, a specificity of 69.7%, and a PPV of 20.8%.
    • doi: 10.1038/s41390-020-0963-x
  • Acute Kidney Injury and Bronchopulmonary Dysplasia in Premature Neonates Born Less than 32 Weeks' Gestation.
    • Starr MC, Boohaker L, Eldredge LC, Menon S, Griffin R, Mayock DE, Li L, Askenazi D, Hingorani S; Neonatal Kidney Collaborative. Am J Perinatol. 2019 Nov 27.
    • Moderate or severe BPD occurred in 214 of 546 (39%) infants, while death occurred in 32 of 546 (6%); the composite of moderate or severe BPD/death occurred in 246 of 546 (45%). For infants born ≤29 weeks of gestation, the adjusted odds ratio (OR) of AKI and the primary outcome was 1.15 (95% confidence interval [CI] = 0.47-2.86; p = 0.76). Infants born between 29 and 32 weeks of gestation with AKI had four-fold higher odds of moderate or severe BPD/death that remained after controlling for multiple factors (adjusted OR = 4.21, 95% CI: 2.07-8.61; p < 0.001).
    • doi: 10.1055/s-0039-3400311
  • Acute Kidney Injury is Associated with Poor Lung Outcomes in Infants Born ≥32 Weeks of Gestational Age.
    • Starr MC, Boohaker L, Eldredge LC, Menon S, Griffin R, Mayock D, Askenazi D Hingorani S; Neonatal Kidney Collaborative. Am J Perinatol. 2019 Nov 18.
    • CLD occurred in 82/1,348 (6.1%) infants, while death occurred in 22/1,348 (1.6%); the composite of CLD/death occurred in 104/1,348 (7.7%). Infants with AKI had an almost five-fold increased odds of CLD/death, which remained after controlling for GA, maternal polyhydramnios, multiple gestations, 5-minute Apgar's score, intubation, and hypoxic-ischemic encephalopathy (adjusted odds ratio [OR] = 4.9, 95% confidence interval [CI]: 3.2-7.4; p<0.0001). Infants with AKI required longer duration of respiratory support (count ratio = 1.59, 95% CI: 1.14-2.23, p = 0.003) and oxygen (count ratio = 1.43, 95% CI: 1.22-1.68, p<0.0001) compared with those without AKI.
    • doi: 10.1055/s-0039-1698836
  • The impact of fluid balance on outcomes in premature neonates: a report from the AWAKEN study group.
    • Selewski DT, Gist KM, Nathan AT, Goldstein SL, Boohaker LJ, Akcan-Arikan A, Bonachea EM, Hanna M, Joseph C, Mahan JD, Mammen C, Nada A, Reidy K, Staples A, Wintermark P, Griffin R, Askenazi DJ, Guillet R; Neonatal Kidney Collaborative. Pediatr Res. 2019 Sep 19.
    • One hundred and forty-nine (14.8%) were on MV at postnatal day 7. The median peak FB was 0% (IQR: −2.9, 2) and occurred on postnatal day 2 (IQR: 1,5). Multivariable models showed that the peak FB (aOR 1.14, 95% CI 1.10–1.19), lowest FB in first postnatal week (aOR 1.12, 95% CI 1.07–1.16), and FB on postnatal day 7 (aOR 1.10, 95% CI 1.06–1.13) were independently associated with MV on postnatal day 7. In a similar analysis, a negative FB at postnatal day 7 protected against the need for MV at postnatal day 7 (aOR 0.21, 95% CI 0.12–0.35).
    • doi: 10.1038/s41390-019-0579-1
  • The Association of Intraventricular Hemorrhage and Acute Kidney Injury in Premature Infants from the Assessment of the Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) Study.
    • Stoops C., Boohaker L., Sims B., Griffin R., Selewski D.T., Askenazi D., on behalf of the National Kidney Collaborative (NKC). Neonatology. 2019 Aug 28:1-10.
    • AKI was documented in 22.2% (183/825) of infants and IVH in 14.3% (118/825). Infants with AKI (n = 183) were more likely to have IVH (26.8%, 49/183) than those without AKI (n= 642) who had IVH (10.7%, 69/642, p < 0.0001). After controlling for 5-min Apgar score, vasopressor support within the first week of age, and gestational age, infants with AKI had 1.6 times higher adjusted odds to develop any grade IVH (95% CI 1.04–2.56). Furthermore, infants of gestational age of 22–28 weeks had 1.9 times higher adjusted odds to develop IVH (OR 1.87, 95% CI 1.08–3.23).
    • doi: 10.1159/000501708
  • Incidence and Risk Factors of Early Onset Neonatal AKI
    • Jennifer R. Charlton, Louis Boohaker, David Askenazi, Patrick D. Brophy, Carl D’Angio, Mamta Fuloria, Jason Gien, Russell Griffin, Sangeeta Hingorani, Susan Ingraham, Ayesa Mian, Robin K. Ohls, Shantanu Rastogi, Christopher J. Rhee, Mary Revenis, Subrata Sarkar, Alexandra Smith, Michelle Starr, Alison L. Kent and on behalf of the Neonatal Kidney Collaborative. CJASN February 2019
    • In over 2,000 patients, early AKI (≤7 days) occurred in 21% of neonates. Infants with early AKI had higher risk of death (aOR 2.8, 95% CI 1.7 to 4.7) and longer length of stay (7.3 days, 95% CI 4.7 to 10). Risk factors for early AKI are: outborn delivery; resuscitation with epinephrine; admission diagnosis of hyperbilirubinemia, inborn errors of metabolism, or surgical need; frequent kidney function surveillance; and admission to a children’s hospital. Protective factors were: multiple gestations, cesarean section, and exposures to antimicrobials, methylxanthines, diuretics, and vasopressors.
    • doi: 10.2215/CJN.03670318
  • Correction to: Acute kidney injury in neonatal encephalopathy: an evaluation of the AWAKEN database
    • Megan J Kirkley, Louis Boohaker, Russell Griffin, Danielle E Soranno, Jason Gien 6, David Askenazi, Katja M Gist; Neonatal Kidney Collaborative (NKC). Pediatr Nephrol. 2019 Feb;34(2):363
    • Erratum for "Acute kidney injury in neonatal encephalopathy: an evaluation of the AWAKEN database." Kirkley MJ, Boohaker L, Griffin R, Soranno DE, Gien J, Askenazi D, Gist KM; Neonatal Kidney Collaborative (NKC). Pediatr Nephrol. 2019 Jan;34(1):169-176. doi: 10.1007/s00467-018-4068-2. Epub 2018 Aug 28. PMID: 30155763
    • doi: 10.1007/s00467-018-4106-0
  • Neonatal Acute Kidney Injury: A Survey of Neonatologists' and Nephrologists' Perceptions and Practice Management.
    • Kent AL, Charlton JR, Guillet R, Gist KM, Hanna M5 El Samra A, Fletcher J, Selewski DT, Mammen C. Am J Perinatol. Jan 2018
    • Many knowledge gaps among neonatologists, and to a lesser extent, pediatric nephrologists were identified. Neonatologists were less likely to use categorical definitions of neonatal AKI (p <0.00001) or diagnose stage 1 AKI (p < 0.00001) than pediatric nephrologists. Guidelines for creatinine monitoring for nephrotoxic medications were reported by 34% (aminoglycosides) and 62% (indomethacin) of respondents. Nephrologists were more likely to consider follow-up after AKI than neonatologists (p < 0.00001). Also, 92 and 86% of neonatologists and nephrologists, respectively, reported no standardization or infrastructure for long-term renal follow-up.
    • doi: 10.1055/s-0037-1604260
  • Association Between Early Caffeine Citrate Administration and Risk of Acute Kidney Injury in Preterm Neonates: Results from the AWAKEN Study.
    • Harer MW, Askenazi DJ, Boohaker LJ, Carmody JB, Griffin RL, Guillet R, Selewski DT, Swanson JR, Charlton JR, Neonatal Kidney Collaborative (NKC). JAMA Pediatrics. April 2018
    • Of 675 preterm infants ≤ 33 weeks, AKI occurred less frequently in neonates who received caffeine than those who did not (50 of 447 (11.2%) vs. 72 of 228 (31.6%), P<0.01). After multivariable adjustment, the number needed to treat to prevent one case of AKI was 4.3 and those receiving caffeine were less likely to develop high grade AKI (stage 2 or 3, OR 0.20, 95% CI 0.12-0.34).
    • doi: 10.1001/jamapediatrics.2018.0322
  • Correction: Incidence of neonatal hypertension from a large multicentre study [Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates-AWAKEN]
    • Emily J Kraut, Louis J Boohaker, David J Askenazi, Jeffery Fletcher, Alison L Kent; Neonatal Kidney Collaborative (NKC). Pediatr Res. 2018 Aug;84(2):314
    • Erratum for "Incidence of neonatal hypertension from a large multicenter study [Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates-AWAKEN]." Kraut EJ, Boohaker LJ, Askenazi DJ, Fletcher J, Kent AL; Neonatal Kidney Collaborative (NKC). Pediatr Res. 2018 Aug;84(2):279-289. doi: 10.1038/s41390-018-0018-8. Epub 2018 May 23. PMID: 29795211
    • doi: 10.1038/s41390-018-0107-8
  • Incidence of neonatal hypertension from a large multicenter study [Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates – AWAKEN]
    • Emily J. Kraut, Louis J. Boohaker, David J. Askenazi, Jeffery Fletcher, Alison L. Kent & on behalf of the Neonatal Kidney Collaborative (NKC). Pediatric Research. May 2018
    • Of over 2,000 infants, hypertension was documented in 1.8% and an additional 3.7% were defined as having undiagnosed hypertension. Hypertension was associated with a diagnosis of AKI and other risk factors for HTN were hyperbilirubinemia, Caucasian race, outborn, vaginal delivery and congenital heart disease. Protective factors were SGA, multiple gestation and maternal betamethasone.
    • doi: 10.1038/s41390-018-0018-8
  • Acute kidney injury in neonatal encephalopathy: an evaluation of the AWAKEN database.
    • Megan J. Kirkley, Louis Boohaker, Russell Griffin,Danielle E. Soranno, Jason Gien, David Askenazi, Katja M. Gist, On behalf of the Neonatal Kidney Collaborative (NKC). Pediatric Nephrology, August 2018.
    • Of 113 patients with neonatal encephalopathy, 41.6% developed AKI. Risk factors for AKI were outborn, IUGR and presence of meconium at delivery. AKI resulted in longer hospital stays (8.5 days, 95% CI 0.79-16.2).
    • doi: 10.1007/s00467-018-4068-2
  • The impact of fluid balance on outcomes in critically ill near term/term neonates: a report from the AWAKEN study group.
    • David T. Selewski, Ayse Akcan-Arikan, Elizabeth M. Bonachea, Katja M. Gist, Stuart L. Goldstein, Mina Hanna, Catherine Joseph, John D. Mahan, Arwa Nada, Amy T. Nathan, Kimberly Reidy, Amy Staples, Pia Wintermark, Louis J. Boohaker, Russell Griffin, David J. Askenazi, Ronnie Guillet & on behalf of the Neonatal Kidney Collaborative. Pediatric Research, September 2018.
    • The median peak fluid balance was 1.0% and occurred on post-natal day 3. Multivariable models showed the peak fluid balance, lowest fluid balance in 1st postnatal week and fluid balance on postnatal day 7 were independently associated with need for mechanical ventilation on postnatal day 7.
    • doi: 10.1038/s41390-018-0183-9
  • Optimizing the AKI definition during the first postnatal week using Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates (AWAKEN) cohort.
    • David Askenazi, Carolyn Abitbol, Louis Boohaker, Russell Griffin, Rupesh Raina, Joshua Dower, T. Keefe Davis, Patricio E. Ray, Sofia Perazzo, Marissa DeFreitas, Lawrence Milner, Namasivayam Ambalavanan, F. Sessions Cole, Erin Rademacher, Michael Zappitelli, Maroun Mhanna & for the Neonatal Kidney Collaborative. Pediatric Research, December 2018
    • The absolute rise in serum creatinine of 0.3 mg/dL outperformed a ≥50% rise in serum creatinine during the first week of life for predicting mortality. The optimal serum creatinine thresholds to predict AUC and specificity were ≥0.3 and ≥0.6 mg/dL for ≤29 weeks gestational age and ≥0.1 and ≥0.3 mg/dL for > 29 week gestational age. The maximum serum creatinine value provides great specificity.
    • doi: 10.1038/s41390-018-0249-8
  • Late onset neonatal acute kidney injury: results from the AWAKEN study.
    • Jennifer R. Charlton, Louis Boohaker, David Askenazi, Patrick D. Brophy, Mamta Fuloria, Jason Gien, Russell Griffin, Sangeeta Hingorani, Susan Ingraham, Ayesa Mian, Robin K. Ohls, Shantanu Rastogi, Christopher J. Rhee, Mary Revenis, Subrata Sarkar, Michelle Starr, Alison L. Kent & on behalf of the Neonatal Kidney Collaborative (NKC). Pediatric Research, December 2018
    • In over 2,000 patients, late AKI (> 7 days after birth) occurred in 9% of neonates. Infants with late AKI had increased risk of death (aOR 2.1, p=0.02) and longer length of stay (21.9, p<0.001). Risk factors for late AKI are: intubation, oligo- and polyhydramnios, mild-moderate renal anomalies, admission diagnoses of congenital heart disease, necrotizing enterocolitis, surgical need, exposure to diuretics, vasopressors, and NSAIDs, discharge diagnoses of patent ductus arteriosus, necrotizing enterocolitis, sepsis, and urinary tract infection.
    • doi: 10.1038/s41390-018-0255-x
  • Incidence and outcomes of neonatal acute kidney injury (AWAKEN): a multicenter, multinational, observational cohort study.
    • Jetton JG, Boohaker LJ, Sethi SK, Wazir S, Rohatgi S, Soranno DE, Chishti AS, Woroniecki R, Mammen C, Swanson JR, Sridhar S, Wong CS, Kupferman JC, Griffin RL, Askenazi DJ, Neonatal Kidney Collaborative (NKC). Lancet Child Adolescent Health. Sept 2017
    • In over 2,000 infants admitted to the NICU on IVF for at least 48 hours, 30% developed AKI based on the neonatal KDIGO definition. AKI varies by gestational age at birth: 48% for those born 22-29 weeks, 18% for 29-35 weeks and 37% for babies ≥ 36 weeks. Babies with AKI have higher mortality (OR 4.6, 95% CI 2.5-8.3) and longer length of hospital stay (8.8 days, 95% CI 6.1-11.5) after adjusting for multiple confounding factors.
    • doi: 10.1016/S2352-4642(17)30069-X
  • Assessment of Worldwide Acute Kidney Injury Epidemiology in Neonates: Design of a Retrospective Cohort Study.
    • Jennifer G. Jetton, Ronnie Guillet, David J. Askenazi, Lynn Dill, Judd Jacobs, Alison L. Kent, David T. Selewski, Carolyn L. Abitbol, Fredrick J. Kaskel, Maroun J. Mhanna, Namasivayam Ambalavanan, Jennifer R. Charlton and the Neonatal Kidney Collaborative. Frontiers in Pediatrics. July 2016
    • Describes the formation of the NKC and establishment of the AWAKEN cohort and database – the largest most inclusive neonatal AKI study to date.
    • doi: 10.3389/fped.2016.00068