1/17/2024 0 Comments Baby ninja uses5 Currently at Children's Healthcare of Atlanta (CHOA), the NINJA program has been implemented in the Hematology/Oncology Unit and the Bone Marrow Transplant Unit because these are areas associated with high nephrotoxin exposure. The overarching goal is to ensure children only receive the NTMx they need for the duration they need them. NINJA aims to increase awareness and prevent NTMx-AKI by recommending daily monitoring of SCr and reducing nephrotoxin exposure when possible. In 2011, the team at Cincinnati Children's Hospital pioneered the Nephrotoxic Injury Negated by Just-in-time Action (NINJA) program, a quality improvement initiative that aims to improve safety and avoid harm from NTMx exposure in hospitalized children. 1 A similar study published by Askenazi et al 4 found that approximately one quarter of hospitalized patients with CF will develop AKI, suggesting that the incidence of AKI in this patient population is higher than what has previously been reported in the literature. The use of aminoglycosides as first-line therapy for CF patients has become a standard of care due to their pharmacologic activity against the most common offending respiratory pathogen in CF patients, Pseudomonas aeruginosa. Certain patient populations, such as those with cystic fibrosis (CF), are routinely exposed to NTMx during hospitalization for pulmonary exacerbations. 2 Moffett et al 3 found that NTMx-AKI rates reach 19% to 31% in children who receive an IV aminoglycoside for more than 5 days, and the rate of AKI doubles when children receive 3 or more NTMxs simultaneously. 1 Nephrotoxic medication-–associated AKI (NTMx-AKI) has been identified as the primary cause of 16% of pediatric AKI cases. Acute kidney injury (AKI) is defined as an abrupt decline in renal function and is assessed by clinical biomarkers, such as serum creatinine (SCr) and urine output.
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