Nephrotoxic medications and acute kidney injury risk factors in the neonatal intensive care unit: clinical challenges for neonatologists and nephrologists

Abstract

Neonatal acute kidney injury (AKI) is common. Critically ill neonates are at risk for AKI for many reasons including the severity of their underlying illnesses, prematurity, and nephrotoxic medications. In this educational review, we highlight four clinical scenarios in which both the illness itself and the medications indicated for their treatment are risk factors for AKI: sepsis, perinatal asphyxia, patent ductus arteriosus, and necrotizing enterocolitis. We review the available evidence regarding medications commonly used in the neonatal period with known nephrotoxic potential, including gentamicin, acyclovir, indomethacin, vancomycin, piperacillin–tazobactam, and amphotericin. We aim to illustrate the complexity of decision-making involved for both neonatologists and pediatric nephrologists when managing infants with these conditions and advocate for ongoing multidisciplinary collaboration in the development of better AKI surveillance protocols and AKI mitigation strategies to improve care for these vulnerable patients.

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Acknowledgments

The authors thank Liza Kramer, PharmD Candidate, Class of 2019, University of Iowa College of Pharmacy; and Whitni Patterson, Pharm D Candidate, Class of 2019, University of Iowa College of Pharmacy.

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Correspondence to Jennifer G. Jetton.

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Study questions’ answers

1. b; 2. a; 3. a, c, d; 4. a; 5. b

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Murphy, H.J., Thomas, B., Van Wyk, B. et al. Nephrotoxic medications and acute kidney injury risk factors in the neonatal intensive care unit: clinical challenges for neonatologists and nephrologists. Pediatr Nephrol 35, 2077–2088 (2020). https://doi.org/10.1007/s00467-019-04350-3

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Keywords

  • Nonsteroidal anti-inflammatory drugs
  • Antibiotics
  • Hypoxic ischemic encephalopathy
  • Patent ductus arteriosus
  • Neonatal sepsis
  • Necrotizing enterocolitis