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Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."
Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011
Dr. Shankar P.R.
"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."
Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011 Anuradha
Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.
Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020
Original article / research
Full Version
Aetiological Profile and Outcomes of Acute Kidney Injury among Neonates Admitted in a Neonatal Intensive Care Unit at a Tertiary Care Hospital, Northeast India: A Prospective Cohort Study
Correspondence Address :
Dulal Kalita,
House No. 24, Adarshapur, Byelane-4, Kahilipara, Guwahati-781019, Assam, India.
E-mail: dulalkalita68@gmail.com
Introduction: Acute Kidney Injury (AKI) affects approximately 8%-24% of critically ill neonates, with a mortality rate ranging from 10%-61%. Groups of newborns at higher risk for AKI include those with perinatal hypoxia, Respiratory Distress Syndrome (RDS), premature and very low birth weight infants, and newborns with sepsis. AKI is associated with poor short-term and long-term outcomes and has a multifactorial aetiology.
Aim: To evaluate the aetiological profile and short-term outcomes of AKI in neonates admitted to the Neonatal Intensive Care Unit (NICU).
Materials and Methods: A prospective cohort (descriptive) study was conducted in the NICU at Gauhati Medical College and Hospital, Guwahati, Assam, India, over a period of one year, from September 1, 2021, to August 31, 2022. A total of 100 neonates exhibiting signs and symptoms of AKI according to Acute Kidney Injury Network (AKIN) criteria. Detailed neonatal history, including neonatal resuscitation, history of perinatal asphyxia, signs and symptoms of sepsis, Respiratory Distress Syndrome (RDS), or any other symptoms, were recorded. The course and outcome of the neonates during their NICU stay were noted. Data were presented in terms of frequency (n) and percentages (%).
Results: Among the 100 AKI neonates, 58 were males and 42 were females, with a male-to-female ratio of 1.38:1. Out of 100 neonates, birth asphyxia constituted 40 (40%) cases, of cases, followed by sepsis in 30 (30%), RDS 27 (27%), dehydration 2 (2%), and obstructive uropathy in 1 (1%) case. Among the 100 AKI neonates, 64 (64%) cases were discharged, 35 (35%) expired, and 1 (1%) were transferred to the paediatric surgery department.
Conclusion: Neonatal AKI is an independent contributor to morbidity and mortality. Therefore, early identification and prompt management are crucial for improving outcomes and prognosis.
Mortality, Newborn, Oliguria, Perinatal asphyxia, Sepsis
The AKI is characterised by diminished urine output (oliguria), an increase in serum creatinine and blood urea, and alterations in serum electrolytes. It also affects extracellular fluid volume and the acid-base homeostasis of the body (1). AKI is a significant contributor to neonatal mortality and morbidity. The prevalence of AKI varies in different NICUs. Various researchers in different parts of the world have estimated the prevalence of AKI to be in the range of 8% to 24% (1),(2),(3). Newborns are more vulnerable to AKI than older children due to their functionally immature kidneys (4). Moreover, critically ill neonates are at an even higher risk due to exposure to several additional risk factors such as prematurity, pregnancy-induced hypertension, prolonged rupture of membranes, and meconium-stained amniotic fluid, etc., (5),(6). In the neonatal period, AKI is more common in the first week of life due to hypovolaemia, hypertension, ischaemia, and less commonly due to primary kidney disease (7). The cause of AKI in neonates is multifactorial, and there are usually one or more associated contributing factors. The origin of AKI in newborns may arise in the prenatal, perinatal, and postnatal periods, or it can be due to a combination of causes. Various studies have mentioned that perinatal asphyxia and neonatal sepsis are the most common causes. Other associated conditions include RDS, dehydration, heart failure, nephrotoxic drugs, and urological anomalies (8),(9),(10),(11). Neonatal AKI is an under-recognised morbidity in neonates. Neonatal AKI is associated with high mortality, and various researchers have reported mortality rates ranging from 32% to 44% in different NICUs (12),(13),(14),(15). Many studies have been conducted by researchers in different parts of the world to study AKI among neonates and evaluate the risk factors, aetiological factors, and outcomes over time (10),(11),(12),(13),(14),(15),(16),(17),(18),(19),(20). However, to the best of the authors knowledge, no similar type of study on AKI in neonates has been conducted in the state of Assam. Nevertheless, two studies were conducted on AKI in older children in the state of Assam in 2017 and 2018 [21,22]. Hence, under this background, the present study was conducted to evaluate the aetiological profile and short-term outcome of AKI in neonates in the NICU.
A prospective cohort (descriptive) study was conducted in the NICU at Gauhati Medical College and Hospital, Guwahati, Assam, India, over a period of one year, from September 1, 2021, to August 31, 2022. The study was approved by the Institutional Ethics Committee (IEC) of Gauhati Medical College and Hospital, Guwahati (Ethical approval no: MC/190/2007/pt-11/july2021/TH-22 Dated 26/07/2021). Informed written consent was obtained from the parents of the neonates enrolled in the study in their native language.
Inclusion criteria: Newborns with a gestational age of 28 weeks or more and birth weight of more than 1 kg, admitted to the NICU, diagnosed with AKI, of either sex were included in the study.
Exclusion criteria: Neonates with a gestational age less than 28 weeks and a birth weight less than 1 kg. Neonates with major congenital malformations or life-threatening anomalies were excluded from the study.
Study Procedure
The study population comprised neonates admitted to the NICU with signs and symptoms suggestive of AKI, who fulfilled the inclusion and exclusion criteria, and were diagnosed based on the AKIN criteria (9),(20), using serum creatinine level and urine output as shown in (Table/Fig 1),(Table/Fig 2). These laboratory-confirmed cases of AKI were enrolled in the study. Thus, a total of 100 consecutively diagnosed neonates with AKI were included. Detailed neonatal history, including neonatal resuscitation, history of perinatal asphyxia, signs and symptoms of sepsis, RDS, or any other symptoms, were recorded. The neonates’ gestational age was determined using the New Ballard scoring system (6). A thorough clinical examination was performed, and general physical examination and vitals of the newborns were recorded. Renal function tests (serum creatinine, blood urea) and serum electrolytes (sodium, potassium) were performed for all cases. Other laboratory tests, such as sepsis screen and blood culture for suspected neonatal sepsis, chest X-ray for RDS, and abdominal ultrasonography, were conducted if renal anomaly was suspected. The babies with AKI were managed through supportive care, fluid adjustment, medication dose adjustments based on renal function, and peritoneal dialysis. Electrolyte disturbances were treated according to standard protocol. The course and outcome of the neonates during the NICU stay and details of the treatment history were noted.
Statistical Analysis
The data collected from the patients were formatted into Microsoft Excel sheets to generate master charts and tables. The data were expressed in terms of frequency and percentage.
Out of 1130 admitted neonates in the NICU screened for AKI, 100 cases were diagnosed as AKI during the study period, constituting 8.8%. Among the 100 AKI neonates, 58% were males and 42% were females, with a male-to-female ratio of 1.38:1. Regarding the distribution of birth weights, neonates weighed 1 to 1.5 kg (22%), 1.5 kg to 2.5 kg (60%), and above 2.5 kg (18%), with an average birth weight of 2240±730 g. According to gestational maturity, 33% were preterm, 53% were term, and 14% were post-term neonates (Table/Fig 3).
In the current study, it was observed that out of 100 neonates with in 40 (40%) cases, were due to perinatal asphyxia, followed by neonatal sepsis in 30 (30%) and RDS in 27 (27%) cases (Table/Fig 4). The analysis of renal function tests and serum electrolytes showed that the mean creatinine was 2.24±0.59 mg/dL, and the mean urea was 118.61±19.28 mg/dL (Table/Fig 5).
The present study showed that according to the site of injury, pre-renal causes constituted 41%, renal causes constituted 58%, and post-renal causes constituted 1% of cases. Peritoneal dialysis was performed in 15 out of 100 neonates with AKI. Among these 100 neonates, 64 (64%) were successfully discharged from the NICU, and 35 neonates (35%) expired. One newborn diagnosed with posterior urethral valve was transferred to the paediatric surgery ward for further management (Table/Fig 6).
The incidence of AKI in various studies ranged from 8% to 24% (1),(2),(3). The neonatal kidney is particularly more vulnerable to AKI than older children due to their functionally immature kidneys. Renal blood flow in newborns is compromised due to high renal vascular resistance and plasma renin activity (4),(6). The incidence of AKI in our NICU was 8.8% during the study period. Kapoor K et al., and Youssef D et al., reported incidences of 9.6% and 10.8%, respectively (5),(15). However, Gallo D et al., reported a low incidence of 1.5%, and Bansal SC et al., reported an incidence of 4.24% in their studies (12),(16). This wide variability in the incidence of AKI in the available data from different units may be due to different definitions of AKI {AKIN criteria, pRIFLE (Pediatric Risk, Injury, Failure, Loss, End Stage Renal Disease) criteria etc.} or the exclusion and inclusion criteria being used.
The gender distribution of AKI neonates revealed that male neonates (58%) were commonly affected compared to female neonates (42%). When comparing this result with a few other studies, Kapoor K et al., reported a male-to-female ratio of 2.6:1, Mortazavi F et al., reported a ratio of 2:1, and Gallo D et al., reported a ratio of 1.8:1, respectively (5),(8),(12). All these researchers observed a higher incidence of AKI in male neonates. The reason for the high incidence of AKI in male neonates may be due to a higher number of admissions of male neonates during this period. In the present study, most common cause of AKI was perinatal asphyxia (40%), followed by neonatal sepsis (30%) and RDS (27%). Many researchers have reported the association of perinatal asphyxia and neonatal AKI. The most common aetiological factor of AKI was found to be perinatal asphyxia in the studies conducted by Gallo D et al., (72%) and Nandhagopal N et al., (74%), respectively (12),(18).
Furthermore, Kaur S et al., also reported an incidence of 41.67% of AKI, and Selewski DT et al., reported that 38% of AKI cases were due to perinatal asphyxia (4),(9). Mangshetty R et al., reported a low incidence of AKI (6.3%) in perinatal asphyxia (17). Neonatal sepsis has consistently been associated with the development of AKI in neonates (7),(8),(10),(19),(20). The current study showed that neonatal sepsis was present in 30% of AKI cases. Timovska SN et al., reported neonatal sepsis in 28% of cases, while Mangshetty R et al., reported a very high incidence of AKI (78%) (13),(17). Neonatal sepsis is a predisposing factor for AKI due to the dual effect of hypotension secondary to sepsis and a direct damaging effect on renal microvasculature (13),(16). In the present study, the analysis of the outcome of the AKI neonates revealed a mortality rate of 35%. The present study’s finding was similar to the results obtained by Momtaz HE et al., (36.5%), Gallo D et al., (35%), Timovska SN et al., (32%), and Bolat F et al., (23.8%) (11),(12),(13),(14). The highest mortality rate of AKI in neonates was found in the study conducted by Youssef D et al., which was 44.4% (15).
Limitation(s)
There were several limitations to the present study. Firstly, it was an observational study with a small sample size and was conducted in a short period of time. Secondly, the data was collected from a single centre, which reduces generalisability. Additionally, there is variability in the diagnosis criteria of AKI in neonates, and authors used AKIN criteria in the current study. Therefore, the frequency of AKI may be different if other criteria are applied. While evaluation the outcome of AKI, the neonates were divided into two groups - survival and mortality. Neonates who progressed to chronic kidney disease were included in the survival group. However, authors did not conduct long-term follow-up of the cases, so could not be commented on delayed renal sequelae. Further studies are needed in this region for a longer period to evaluate the aetiological profile and outcome of newborns with AKI.
The identified aetiological factors for neonatal AKI in the present study were perinatal asphyxia (40%), followed by neonatal sepsis (30%) and RDS (27%). It is important to appropriately manage these risk factors in the NICU to prevent complications. The analysis of the short-term outcome of the AKI neonates in the study revealed a mortality rate of 35%. AKI is a reversible cause of neonatal mortality if detected in the early stage, highlighting the importance of prompt treatment for good outcomes.
DOI: 10.7860/JCDR/2023/66748.18712
Date of Submission: Jul 26, 2023
Date of Peer Review: Sep 11, 2023
Date of Acceptance: Oct 18, 2023
Date of Publishing: Nov 01, 2023
AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA
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