Acute kidney injury in neonates

Acute kidney injury (AKI) is a common and serious complication among infants admitted to neonatal intensive care units, affecting up to one-third of hospitalized neonates and contributing to significant short- and long-term morbidity and mortality. The unique physiology of the developing kidney, coupled with diverse neonatal comorbidities, creates both susceptibility to injury and challenges in timely diagnosis. Recent multicenter epidemiologic studies have clarified the incidence, risk factors, and outcomes of neonatal AKI, emphasizing the importance of standardized definitions and early recognition. Advances in monitoring strategies—including near-infrared spectroscopy and early biomarkers of renal stress—offer opportunities for earlier detection, while heightened attention to fluid balance, nephrotoxic stewardship, and targeted pharmacologic interventions support primary and secondary prevention. For infants requiring kidney support, technological innovation has expanded the feasibility and safety of renal replacement therapies, even in the smallest patients. Emerging evidence also highlights strong associations between neonatal AKI, prematurity, and long-term kidney health, prompting new consensus recommendations for risk-stratified outpatient surveillance. This review synthesizes current knowledge and recent advances in neonatal AKI, underscoring the need for proactive, multidisciplinary approaches to preserve kidney health from the earliest stages of life into child- and adulthood.