AKI Linked to Poor Neurodevelopment in Preterm Infants: JAMA

A recent study published in the Journal of the American Medical Association revealed that acute kidney injury (AKI) in preterm infants was associated with worse neurodevelopmental impairment (NDI) at 22–26 months’ corrected age, as measured by BSID-III scores.

The findings emerge from a secondary review of data from the Preterm Erythropoietin Neuroprotection Trial (PENUT), across 30 neonatal intensive care units in the United States between December 2013 and September 2016. This study focused on infants born between 24 and 27 weeks of gestation, who are already highly vulnerable to long-term developmental complications. The data were analyzed in February 2024 to explore whether AKI might be linked to adverse developmental outcomes as children age.

Of the 941 infants originally enrolled, 660 had complete follow-up data at 22 to 26 months’ corrected gestational age using the Bayley Scales of Infant Development III (BSID-III), a standardized measure of cognitive and motor skills. Among these survivors, 39% (256 infants) experienced AKI during their hospitalization.

Infants who developed AKI differed significantly from those who did not, as they were born earlier, with a mean gestational age of 25.1 weeks compared with 25.7 weeks, and weighed less at birth, averaging 755 grams vs 825 grams. They were also more likely to have struggled immediately after delivery where 24.1% had an Apgar score below 5 at 5 minutes, when compared to 17.1% of infants without AKI. Also, 57% of affected infants were male, which mirrored known trends in vulnerability among premature males.

The primary outcome measured was a composite of death or moderate to severe NDI, defined as cerebral palsy, or BSID-III cognitive or motor scores below 85. The study revealed a significant increase in risk associated with AKI (the adjusted odds ratio was 1.53), where the infants with AKI were more than 50% more likely to die or experience serious neurodevelopmental challenges than those without kidney injury. Also, AKI was strongly linked to poorer cognitive outcomes, with nearly double the odds (1.94 AOR) of scoring below 85 on the BSID-III cognitive scale.

Neither the timing (early versus late onset) nor the severity of AKI changed the strength of this association, suggesting that the presence of AKI alone represents an important risk marker. Overall, the results of this study suggest the need for improved monitoring and strategies to protect kidney health in the neonatal intensive care setting, where survival rates continue to improve but long-term quality of life remains a pressing concern.

Source:

Hanna, M., Chock, V. Y., Kamath, N., Raj, A., Swanson, J. R., Griffin, R., Askenazi, D. J., & Nesargi, S. (2025). Acute kidney injury and neurodevelopmental outcomes in extremely premature neonates: A secondary analysis of a randomized clinical trial: A secondary analysis of a randomized clinical trial. JAMA Network Open, 8(11), e2543270. https://doi.org/10.1001/jamanetworkopen.2025.43270