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Necrotizing Enterocolitis associated Acute Kidney Injury - transforming the paradigm.

Necrotizing enterocolitis (NEC) is one of the most common conditions requiring emergency surgery in the neonatal intensive care unit and is associated with a septic shock-like state contributing to multi-organ dysfunction. NEC affects 6-10% of very-low birth-weight infants and remains a leading cause of death. The occurrence of severe AKI following surgical NEC is a harbinger of multiple morbidities. This review presents current evidence about the clinical impact of NEC associated AKI on the clinical outcomes. Studies evaluating nephro-protective strategies to prevent AKI and its consequences are greatly needed to improve the post-operative recovery and clinical outcomes in neonates with NEC. Future observational studies and clinical trials in preterm-born infants with NEC prioritize measuring short-term (AKI) and longer term (chronic kidney disease) kidney outcomes. Impact: 1. Severe AKI (stage 2 and 3) occurs in 32.6% of neonates after NEC diagnosis and in 58.7% following surgical NEC diagnosis. 2. NEC associated AKI is associated with severe postoperative course, moderate to severe bronchopulmonary dysplasia, surgical complications, brain injury and longer hospital stay in preterm infants. 3. Severity of NEC associated AKI can be utilized by bedside providers for the prognostication of clinical outcomes in preterm infants.

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