Post-asphyxia acute kidney injury in neonates: a systematic review

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: 20-60% incidence range

• Primary Outcome: AKI incidence in neonates with perinatal asphyxia

• Nnt Or Sensitivity: Strong association with severe asphyxia and multi-organ dysfunction

• Confidence Interval: Not reported

Clinical Application

Applicable with standard neonatal monitoring protocols and emerging biomarker availability Relevant to Australian neonatal units with access to CRRT and standardized KDIGO criteria; aligns with ANZNN registry data collection Term and preterm neonates with perinatal asphyxia in Australian NICUs

Abstract

UNLABELLED: Perinatal asphyxia is a major cause of neonatal morbidity and mortality globally. It affects multi-systems and has significant renal consequences. Acute kidney injury (AKI) is a frequent complication of perinatal asphyxia; however, its burden, diagnosis, and outcomes remain variably characterized. This study employed a scoping review approach to map and synthesize the existing evidence on post-asphyxia AKI in neonates. A total of 30 studies published between 1995 and 2025 were included, encompassing different geographic regions, study designs, and diagnostic criteria. The review demonstrates a clear growth in scholarly attention to post-asphyxia AKI, particularly in the last 25 years, coinciding with the introduction of neonatal-modified KDIGO definitions and advances in neonatal nephrology. Reported incidence of AKI varied widely, ranging from 20% to over 60%, reflecting non-homogeneity in study populations, differing case definitions of acute kidney injury in neonates, the severities of hypoxic-ischemic encephalopathy, and varied methodological approaches. Findings consistently indicate that AKI is strongly associated with severe forms of perinatal asphyxia, the presence of multi-organ dysfunction, prolonged neonatal intensive care stay, and mortality. CONCLUSION: Despite emerging interest in novel biomarkers and standard definitions, important gaps persist in early detection, long-term renal outcome data, and evidence from low- and middle-income countries. Addressing these gaps through standardized monitoring, biomarker validation, and longitudinal follow-up will improve renal survival in neonates affected by perinatal asphyxia. WHAT IS KNOWN: • The newborn kidneys are susceptible to the hemodynamic changes that follow ischemia/asphyxia due to a poor functioning capacity and oftentimes an inadequate structural potential. • Neonatal AKI is closely linked to severe forms of asphyxia, increased length of hospital stay and increased mortality. its reported incidence is widely varied. WHAT IS NEW: • The emergence of novel biomarkers in the identification and diagnosis of neonatal AKI, and the uptake and application of standard definitions (modified neonatal KDIGO) in the identification of neonatal AKI. • The availabiltiy of specialized kidney support therapy (continuous kidney replacement therapy; the carpadiem) in the management of neonatal AKI.

References

1. 1.Aderounmu, T., Adeyemi, B., & Bolarinwa, A. (2026). Post-asphyxia acute kidney injury in neonates: a systematic review. European Journal of Pediatrics. https://doi.org/10.1542/peds.2014-3819