unger children (1–24 months), higher UO thresholds were not better than the adult Kidney Disease Improving Global Outcomes criteria. Background Pediatric AKI is associated with significant morbidity and mortality, yet a precise definition, especially concerning urine output (UO) thresholds, remains unproven. We evaluate UO thresholds for AKI in neonates and children aged 1–24 months with indwelling urinary catheters undergoing cardiac surgery. Methods A 6-year prospective cohort study (2018–2023) after cardiac surgery was conducted at a reference center in Brazil. All patients had indwelling urinary catheters up to 48 hours after surgery and at least two serum creatinine measurements, including one before surgery. The main objective of this study was to determine the optimal UO thresholds for AKI definition and staging in neonates and younger children compared with the currently used criteria—neonatal and adult Kidney Disease Improving Global Outcomes (KDIGO) definitions. The outcome was a composite of severe AKI (stage 3 AKI diagnosed by the serum creatinine criterion only), KRT, or hospital mortality. Results The study included 1024 patients: 253 in the neonatal group and 772 in the younger children group. In both groups, the lowest UO at 24 hours as a continuous variable had good discriminatory capacity for the composite outcome (area under the curve-receiver operating characteristic 0.75 [95% confidence interval, 0.70 to 0.81] and 0.74 [95% confidence interval, 0.68 to 0.79]). In neonates, the best thresholds were 3.0, 2.0, and 1.0 ml/kg per hour, and in younger children, the thresholds were 1.8, 1.0, and 0.5 ml/kg per hour. These values were used for modified AKI staging for each age group. In neonates, this modified criterion was associated with the best discriminatory capacity (area under the curve-receiver operating characteristic 0.74 [0.67 to 0.80] versus 0.68 [0.61 to 0.75], P < 0.05) and net reclassification improvement in comparison with the neonatal KDIGO criteria. In younger children, the modified criteria had good discriminatory capacity but were comparable with the adult KDIGO criteria, and the net reclassification improvement was near zero. Conclusions Using indwelling catheters for UO measurements, our study reinforced that the current KDIGO criteria may require adjustments to better serve the neonate population. In addition, using the UO criteria, we validated the adult KDIGO criteria in children aged 1–24 months....

中文翻译：

---

新生儿/年幼儿童尿量和急性肾损伤：留置导尿管心脏手术患者的前瞻性研究


unger 儿童 （1-24 个月），较高的 UO 阈值并不优于成人肾病改善全球结局标准。背景 儿科 AKI 与显着的发病率和死亡率相关，但确切的定义，尤其是关于尿量 （UO） 阈值，仍未得到证实。我们评估了接受心脏手术的留置导尿管新生儿和 1-24 个月龄儿童的 AKI 的 UO 阈值。方法 在巴西的参考中心进行了一项为期 6 年的心脏手术后前瞻性队列研究 （2018-2023）。所有患者在手术后 48 小时内均留置导尿管，并且至少进行了两次血清肌酐测量，包括一次手术前。本研究的主要目的是确定新生儿和年幼儿童 AKI 定义和分期的最佳 UO 阈值，与目前使用的标准——新生儿和成人肾病改善全球结局 （KDIGO） 定义进行比较。结局是严重 AKI （仅通过血清肌酐标准诊断的 3 期 AKI） 、 KRT 或医院死亡率的复合结局。结果 该研究包括 1024 例患者： 新生儿组 253 例，年幼儿童组 772 例。在两组中，作为连续变量的 24 小时时最低 UO 对复合结局具有良好的区分能力 （曲线下面积-受试者工作特征 0.75 [95% 置信区间，0.70 至 0.81] 和 0.74 [95% 置信区间，0.68 至 0.79]）。在新生儿中，最佳阈值为 3.0 、 2.0 和 1.0 ml/kg 每小时，在年幼儿童中，阈值为 1.8 、 1.0 和 0.5 ml/kg 每小时。这些值用于每个年龄组的改良 AKI 分期。 在新生儿中，与新生儿 KDIGO 标准相比，这一修改后的标准与最佳鉴别能力 （曲线下面积-受试者工作特征 0.74 [0.67 至 0.80] 对比 0.68 [0.61 至 0.75] ，P < 0.05 ）和净重分类改善相关。在年幼儿童中，修改后的标准具有良好的区分能力，但与成人 KDIGO 标准相当，净重分类改进接近于零。结论 使用留置导管进行 UO 测量，我们的研究强化了当前的 KDIGO 标准可能需要调整以更好地为新生儿群体服务。此外，使用 UO 标准，我们在 1-24 个月大的儿童中验证了成人 KDIGO 标准。