![]() First, both renal blood flow and perfusion pressure increase over the first weeks of life in neonates. There are several core principles of neonatal physiology that uniquely impact the diagnosis and management of neonatal AKI. Future research needs to be focused on determining the optimal follow-up strategy for neonates with a history of AKI to detect chronic kidney disease. ![]() Moving forward, biomarkers, such as urinary neutrophil gelatinase–associated lipocalin, and other new technologies, such as monitoring of renal tissue oxygenation and nephron counting, will likely play an increased role in identification of AKI and those most vulnerable for chronic kidney disease. With specific continuous renal replacement therapy machines designed for neonates, this therapy is now available and is being used with increasing frequency in NICUs. New technology has resulted in advancement in prevention and improvements in the current management in neonates with severe AKI. New evidence highlights the importance of the kidney in “crosstalk” between other organs and how AKI likely plays a critical role in other organ development and injury, such as intraventricular hemorrhage and lung disease. ![]() Specific progress has been made in identifying potential preventive strategies for AKI, such as the use of caffeine in premature neonates, theophylline in neonates with hypoxic-ischemic encephalopathy, and nephrotoxic medication monitoring programs. The natural course of neonatal AKI, along with the risk factors, mitigation strategies, and the role of AKI on short- and long-term outcomes, is becoming clearer. Large multicenter studies reveal that neonatal AKI is common and independently associated with increased morbidity and mortality. In this state-of-the-art review, we highlight the major advances over the last 5 years in neonatal acute kidney injury (AKI).
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