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Objective: We aimed to identify factors independently associated with the need for inotropic support for low cardiac output or haemodynamic instability after pulmonary artery banding surgery for CHD. Methods: We performed a retrospective chart review of all neonates and infants who underwent pulmonary banding between January 2016 and June 2019 at our institution. Bivariate and multivariable analyses were performed to identify factors independently associated with the use of post-operative inotropic support, defined as the initiation of inotropic infusion(s) for depressed myocardial function, hypotension, or compromised perfusion within 24 hours of pulmonary artery banding. Results: We reviewed 61 patients. Median age at surgery was 10 days (25%,75%:7,30). Cardiac anatomy was biventricular in 38 patients (62%), hypoplastic right ventricle in 14 patients (23%), and hypoplastic left ventricle in 9 patients (15%). Inotropic support was implemented in 30 patients (49%). Baseline characteristics of patients who received inotropic support, including ventricular anatomy and pre-operative ventricular function, were not statistically different from the rest of the cohort. Patients who received inotropic support, however, were exposed to larger cumulative doses of ketamine intraoperatively – median 4.0 mg/kg (25%,75%:2.8,5.9) versus 1.8 mg/kg (25%,75%:0.9,4.5), p < 0.001. In a multivariable model, cumulative ketamine dose greater than 2.5mg/kg was associated with post-operative inotropic support (odds ratio 5.5; 95% confidence interval: 1.7,17.8), independent of total surgery time. Conclusions: Inotropic support was administered in approximately half of patients who underwent pulmonary artery banding and more commonly occurred in patients who received higher cumulative doses of ketamine intraoperatively, independent of the duration of surgery.

Background: Prenatal food insecurity (FI) negatively affects both maternal and infant health. These effects may be even more notable in infants as 1) prematurity and neonatal intensive care unit (NICU) admission increase the risk of kidney disease, 2) maternal malnutrition leads to decreased kidney mass, and 3) FI accelerates the progression of kidney disease.Our aim was to determine the association between FI and kidney health. Methods: Single-site prospective cohort study.Parents of infants admitted to the NICU at Riley Children’s Health at Indiana University, Indianapolis, IN were interviewed. We collected demographic characteristics and FI status using the Hunger Vital Signs (a validated two-question screening tool). Maternal and infant data were abstracted from medical records and kidney outcomes were compared by FI status. Results: A total of 45 infants were enrolled in this study. In the cohort, the mean gestational age was 32 weeks and the average birthweight was 1.8kg. 26 (60%) reported a household income >$50,000 per year and 21 (47%) held an Associate’s degree or higher. Of the cohort, 22% (10/45) lived in FI households. Infants from FI households were more likely to have AKI than those from food secure households (60% vs 17%, p=0.007) and were more likely to have an abnormal serum creatinine at two weeks of age (70% vs 31%, p=0.028). While not statistically significant, infants from FI households had a trend towards higher likelihood of IUGR (30% v 14%). Conclusion: Food insecurity was common among families with infants admitted to the NICU. Infants born into FI households were more likely to have AKI and delayed maturation of kidney function than those born in food secure households. This emphasizes the importance of FI screening as part of prenatal care along with the need for resources such as food pantries for families admitted to the NICU.

To describe three different standardized approaches to improving neonatal acute kidney injury (AKI) identification and the impact on AKI identification, incidence, and nephrology consultation and referral.A retrospective cohort study in three academic NICUs. We compared AKI identification, AKI incidence, nephrology consultation, and nephrology follow-up before and after implantation of local protocols to standardize neonatal AKI identification.Neonatal AKI identification improved in all three NICUs following protocol implementation (26-85%, P 0.0001). Each center also saw increases in nephrology consultation (15-83%, P 0.0001) and nephrology follow-up (7-73%, P 0.0001). AKI incidence decreased significantly (21-12%, P 0.0001).Multiple strategies can be successfully operationalized to improve neonatal AKI identification. While different in approach, each strategy resulted in increased AKI identification and nephrology involvement. This study emphasizes the importance of local standardized approaches to AKI to improve AKI identification and nephrology involvement in the NICU.