Inside Pediatrics Spring/Summer 2026

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Inside Pediatrics provides information, news, and the latest updates from departments and divisions at Children’s of Alabama. Articles and features cover the current developments and discoveries related to pediatric medical research, clinical trials, and treatments happening today. Inside Pediatrics helps keep you connected and up-to-date on the latest breakthroughs and medical advances at Children’s of Alabama.

NEPHROLOGY

NINJA: A Decade of Preventing Acute Kidney Injury Acute kidney injury (AKI) is a common but under-recognized and preventable complication in hospitalized children. That’s why, a decade ago, Children’s of Alabama became the second of now more than 20 pediatric hospitals that are part of the Nephrotoxic Injury Negated by Just-in-Time Action (NINJA) initiative, which aims to prevent AKI in children exposed to nephrotoxic medication. As the hospital marks the 10th anniversary of this initiative, leaders estimate that it has helped them prevent more than 1,000 AKI episodes, and the rate of events continues to drop more and more each year. AKI is hardly a benign condition; even a single episode of AKI can set a child on a trajectory toward hypertension and chronic kidney disease later in life. In non-ICU patients, the most common cause is nephrotoxic medications such as aminoglycosides, NSAIDs, and vancomycin. Historically, the care of these patients was reactive, beginning when severe AKI was found. NINJA was designed to flip the script by taking a preventive approach. Now, children exposed to a high nephrotoxic medication burden—defined as three or more in one day or prolonged aminoglycoside/vancomycin use—are identified, discussed, and screened for early signs of kidney injury. “The NINJA initiative works by helping providers recognize who is at risk for AKI and asking them to be judicious and vigilant,” Children’s pediatric nephrologist David Askenazi, M.D., MSPH, said. “The buy-in has been amazing and a true testament to the hospital’s dedication to a culture of safety. While physicians have an important role, our pharmacists and quality improvement personnel are the critical NINJAs.” Multicenter studies on NINJA published in 2020 show an overall AKI reduction of 62%. Now, the Division of Pediatric Nephrology is working with the hospital’s IT experts to integrate the NINJA system into the EPIC electronic medical record (EMR). “This will enhance the clinician’s ability to see what’s happening in real time and decrease the time burden for data collection” Askenazi said. “Patients who meet NINJA criteria will be flagged immediately, and their providers will have clinical-decision tools to help streamline and optimize care.”