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Objective <p>Racial and ethnic disparities in neonatal postoperative outcomes are reported, but differences in cardiac surgery-associated acute kidney injury (CS-AKI) remain unexamined. We assessed racial/ethnic disparities in CS-AKI prevalence and outcomes in neonates undergoing congenital heart surgery.</p> Design, Setting, and Patients <p>Retrospective cohort of neonates across 22 centers (2015–2018) from the Pediatric Cardiac Critical Care Consortium and the Neonatal and Pediatric Heart and Renal Outcomes Network.</p> Measurements <p>Race/ethnicity (primary predictor) were categorized into eight groups; CS-AKI was defined using neonatal modified Kidney Disease: Improving Global Outcomes criteria as mild (stage 1), severe (≥ stage 2) and persistent (any stage beyond post-operative day [POD] 3). Outcomes included not achieving net negative fluid balance [FB], respiratory support duration, length of stay [LOS], and mortality. Multivariable regression models examining the association between race/ethnicity and outcomes were also constructed.</p> Results <p>Among 2,165 neonates (2% Asian, 18% Hispanic, 1% multi-racial, 0.3% Native American, 14% Non-Hispanic Black (NHB), 59% Non-Hispanic White (NHW), 5% other, and 0.2% Pacific Islander), CS-AKI prevalence (31% mild, 23% severe) did not differ across racial/ethnic groups. NHB neonates had lower birthweight and higher surgical complexity, while NHW neonates had higher private insurance rates. NHB neonates were less likely to not achieve a net negative FB until ≥ POD3 than NHW neonates, but no differences were found in respiratory support duration, hospital LOS, or mortality after multivariate adjustment. Non-white neonates with severe AKI had higher mortality but had similar clinical outcomes.</p> Conclusions <p>CS-AKI rates did not vary by race/ethnicity. Differences in fluid balance achievement were noted but no significant disparities were found in mortality, mechanical ventilation duration, or hospital LOS.</p>

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Exploring Racial and Ethnic Disparities in Outcomes Following Pediatric Cardiac Surgery: A NEPHRON Study Analysis

  • 期刊论文

  • 发表日期：

    2025年10月31日

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  • Jiaxin Huang,
  • Huaiyu Zang,
  • Garrett Reichle,
  • Elaine Ku,
  • Natasha Afonso,
  • Aaron G. DeWitt,
  • Aparna Kulkarni,
  • Sarah Plummer,
  • Kimberly DiMaria,
  • Jessica Thielen,
  • David T. Selewski,
  • Jeffrey Alten,
  • Titus Chan

摘要

Objective

Racial and ethnic disparities in neonatal postoperative outcomes are reported, but differences in cardiac surgery-associated acute kidney injury (CS-AKI) remain unexamined. We assessed racial/ethnic disparities in CS-AKI prevalence and outcomes in neonates undergoing congenital heart surgery.

Design, Setting, and Patients

Retrospective cohort of neonates across 22 centers (2015–2018) from the Pediatric Cardiac Critical Care Consortium and the Neonatal and Pediatric Heart and Renal Outcomes Network.

Measurements

Race/ethnicity (primary predictor) were categorized into eight groups; CS-AKI was defined using neonatal modified Kidney Disease: Improving Global Outcomes criteria as mild (stage 1), severe (≥ stage 2) and persistent (any stage beyond post-operative day [POD] 3). Outcomes included not achieving net negative fluid balance [FB], respiratory support duration, length of stay [LOS], and mortality. Multivariable regression models examining the association between race/ethnicity and outcomes were also constructed.

Results

Among 2,165 neonates (2% Asian, 18% Hispanic, 1% multi-racial, 0.3% Native American, 14% Non-Hispanic Black (NHB), 59% Non-Hispanic White (NHW), 5% other, and 0.2% Pacific Islander), CS-AKI prevalence (31% mild, 23% severe) did not differ across racial/ethnic groups. NHB neonates had lower birthweight and higher surgical complexity, while NHW neonates had higher private insurance rates. NHB neonates were less likely to not achieve a net negative FB until ≥ POD3 than NHW neonates, but no differences were found in respiratory support duration, hospital LOS, or mortality after multivariate adjustment. Non-white neonates with severe AKI had higher mortality but had similar clinical outcomes.

Conclusions

CS-AKI rates did not vary by race/ethnicity. Differences in fluid balance achievement were noted but no significant disparities were found in mortality, mechanical ventilation duration, or hospital LOS.