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To develop a context-specific methodology to assess the 5 A's of food environment: availability, accessibility, affordability, acceptability, and accommodation.Cross-sectional mixed-methods study. Availability of foods was assessed by on-site observation and interviewing vendors. To assess accessibility, buffer zones around food stores were created using geographic information systems. Affordability was controlled by selecting participants from the middle-income group. Accommodation and acceptability were assessed by interviewing vendors and caregivers.Villages of Ghatkesar subdistrict (n = 4), Telangana, South India.Caregivers of children aged 6-10 years (n = 160) and food vendors (n = 68).The quality of the 5 A's was graded on the basis of concurrence between actual and perceived measures.The actual and perceived 5 A's for semiperishable foods matched, and hence the food environment was graded as good across the villages. However, for perishable foods, the food environment was graded as poor with respect to accommodation and acceptability in all villages; and with respect to availability and affordability in at least 2 villages as the actual and perceived measures did not match.This study demonstrated the use of context-specific methods to assess the 5 key dimensions of the food environment, which can be attempted in other contexts with suitable modifications.

Neonatal acute kidney injury (AKI) is common in neonatal intensive care units (NICU) and leads to worse outcomes. Stratifying neonates into an "at risk" category allows health care providers to objectively recognize opportunities for improvements in quality of care.The "Neonatal AKI Risk Prediction Scoring" was devised as the "STARZ [Sethi, Tibrewal, Agrawal, Raina, waZir]" Score. The STARZ score was derived from our prior multicentre study analysing risk factors for AKI in neonates admitted to the NICU. This tool includes 10 variables with a total score ranging from 0 to 100 and a cut-off score of 31.5. In the present study, the scoring model has been validated in our multicentre cohort of 744 neonates.In the validation cohort, this scoring model had sensitivity of 82.1%, specificity 91.7%, positive predictive value 81.2%, negative predictive value 92.2% and accuracy 88.8%. Based on the STARZ cut-off score of ≥ 31.5, an area under the receiver operating characteristic (ROC) curve was observed to be 0.932 (95% CI, 0.910-0.954; p 0.001) signifying that the discriminative power was high. In the validation cohort, the probability of AKI was less than 20% for scores up to 32, 20-40% for scores between 33 and 36, 40-60% for scores between 37 and 43, 60-80% for scores between 44 and 49, and ≥ 80% for scores ≥ 50.To promote the survival of susceptible neonates, early detection and prompt interventional measures based on highly evidenced research is vital. The risk of AKI in admitted neonates can be quantitatively determined by the rapid STARZ scoring system. A higher resolution version of the Graphical abstract is available as Supplementary information.

OBJECTIVE: A rapid AKI risk assessment score would allow for improving management and outcomes. STARZ (Sethi, Tibrewal, Agrawal, Raina, waZir) score was developed for acute kidney injury (AKI) risk stratification of critically ill neonates. This is the first independent validation for the novel score outside the original enrolled centres. STUDY DESIGN: 750 neonates were included in the study. The STARZ score was calculated after 12 hours of admission. Neonates admitted in NICU and receiving IV fluids for at least 48 hours were included. RESULTS: A total of 8.8% neonates had AKI in the first 7 days post admission. The duration of hospital stay was significantly higher among neonates with AKI [10.5 (7–19) vs. 7 (5–10) days; p

Background: Acute kidney injury (AKI) is common in neonates admitted to neonatal intensive care units (NICUs). There is a need to have prospective data on the risk factors and outcomes of acute peritoneal dialysis (PD) in neonates. The use of kidney replacement therapy in this population compared to older populations has been associated with worse outcomes (mortality rates 17–24%) along with a longer stay in the NICU and/or hospital. Methods: The following multicentre, prospective study was derived from the TINKER (The Indian PCRRT-ICONIC Neonatal Kidney Educational Registry) database, assessing all admitted neonates ≤28 days who received intravenous fluids for at least 48 h. The following neonates were excluded: death within 48 h, presence of any lethal chromosomal anomaly, requirement of congenital heart surgery within the first 7 days of life and those receiving only routine care in nursery. Demographic data (maternal and neonatal) and daily clinical and laboratory parameters were recorded. AKI was defined according to the Neonatal Kidney Disease: Improving Global Outcomes criteria. Results: Of the included 1600 neonates, a total of 491 (30.7%) had AKI. Of these 491 neonates with AKI, 44 (9%) required PD. Among neonates with AKI, the odds of needing PD was significantly higher among those with significant cardiac disease (odds ratio (95% confidence interval): 4.95 (2.39–10.27); p < 0.001), inotropes usage (4.77 (1.98–11.51); p < 0.001), severe peripartum event (4.37 (1.31–14.57); p = 0.02), requirement of respiratory support in NICU (4.17 (1.00–17.59); p = 0.04), necrotising enterocolitis (3.96 (1.21–13.02); p = 0.03), any grade of intraventricular haemorrhage (3.71 (1.63–8.45); p = 0.001), evidence of fluid overload during the first 12 h in NICU (3.69 (1.27–10.70); p = 0.02) and requirement of resuscitation in the delivery room (2.72 (1.45–5.12); p = 0.001). AKI neonates with PD as compared to those without PD had a significantly lower median (interquartile range) duration of stay in NICU (7 (4–14) vs. 11 (6–21) days; p = 0.004), but significantly higher mortality (31 (70.5%) vs. 50 (3.2%); p < 0.001). This discrepancy is likely attributable to the critical state of the neonates with AKI. Conclusions: This is the largest prospective, multicentre study specifically looking at neonatal AKI and need for dialysis in neonates. AKI was seen in 30.7% of neonates (with the need for acute PD in 9% of the AKI group). The odds of needing acute PD were significantly higher among those with significant cardiac disease, inotropes usage, severe peripartum event, requirement of respiratory support in NICU, necrotising enterocolitis, any grade of intraventricular haemorrhage, evidence of fluid overload more than 10% during the first 12 h in NICU and requirement of resuscitation in the delivery room. AKI neonates with PD as compared to AKI neonates without PD had a significantly higher mortality. There is a need to keep a vigilant watch in neonates with risk factors for the development of AKI and need for PD.

Supplemental Material, sj-docx-1-ptd-10.1177_08968608221091023 for Risk factors and outcomes of neonates with acute kidney injury needing peritoneal dialysis: Results from the prospective TINKER (The Indian PCRRT-ICONIC Neonatal Kidney Educational Registry) study by Sidharth Kumar Sethi, Sanjay Wazir, Jagdish Sahoo, Gopal Agrawal, Naveen Bajaj, Naveen Parkash Gupta, Shishir Mirgunde, Binesh Balachandran, Kamran Afzal, Anubha Shrivastava, Jyoti Bagla, Sushma Krishnegowda, Ananth Konapur, Azmeri Sultana, Kritika Soni, Nikhil Nair, Divya Sharma, Prajit Khooblall, Avisha Pandey, Khalid Alhasan, Mignon McCulloch, Timothy Bunchman, Abhishek Tibrewal and Rupesh Raina in Peritoneal Dialysis International

Supplemental Material, sj-docx-2-ptd-10.1177_08968608221091023 for Risk factors and outcomes of neonates with acute kidney injury needing peritoneal dialysis: Results from the prospective TINKER (The Indian PCRRT-ICONIC Neonatal Kidney Educational Registry) study by Sidharth Kumar Sethi, Sanjay Wazir, Jagdish Sahoo, Gopal Agrawal, Naveen Bajaj, Naveen Parkash Gupta, Shishir Mirgunde, Binesh Balachandran, Kamran Afzal, Anubha Shrivastava, Jyoti Bagla, Sushma Krishnegowda, Ananth Konapur, Azmeri Sultana, Kritika Soni, Nikhil Nair, Divya Sharma, Prajit Khooblall, Avisha Pandey, Khalid Alhasan, Mignon McCulloch, Timothy Bunchman, Abhishek Tibrewal and Rupesh Raina in Peritoneal Dialysis International