Acute kidney injury associated with increased costs in the neonatal intensive care unit: analysis of Pediatric Health Information System database

Compare neonatal intensive care unit hospitalization costs between neonates with and without AKI; identify predictors of AKI-associated costs. We hypothesized neonates with AKI would amass more costs than those without AKI.

Retrospective, multicenter cohort study of surviving neonates cared for 2015–2021 in Pediatric Health Information System database. The primary outcome was estimated hospitalization costs.

Data from 304,725 neonates were evaluated, 8774 (3%) with AKI and 295,951 (97%) without AKI. Neonates with AKI had $58,807 greater adjusted costs than those without AKI. AKI-associated costs were most strongly driven by Feudtner Pediatric Complex Chronic Conditions Classifications (cardiovascaular, congenital/genetic, gastrointestinal, medical technology) and gestational age. Adjusted costs decreased with increasing gestational age, regardless of AKI status.

AKI is independently associated with increased hospital costs. Knowledge of these drivers can help in identifying high-value practices for cost mitigation strategies.