Objective: To evaluate the efficacy of an innovative "Active Prevention Protocol" (APP)—incorporating early urinary NGAL biomarker screening and a digital fluid management application—compared to standard clinical care in reducing the incidence of severe complications (AKI and Grade III dehydration) in children hospitalized with severe acute intestinal infections. Methods: A prospective, randomized controlled trial was conducted at the [Name of University Hospital] from January 2024 to October 2024. The study enrolled 240 children (aged 1-10 years) admitted with severe AII (defined by Clark scale >12 points). Patients were randomized 1:1 into: Control Group (n=120): Managed according to standard national guidelines (clinical monitoring of urine output, standard chart-based fluid balance). Intervention Group (n=120): Managed via the "Active Prevention Protocol," which included: (1) Urinary NGAL testing at admission and 24h to detect subclinical kidney stress; (2) Use of a custom "Smart-Hydration" mobile app for real-time calculation of fluid loss vs. intake; and (3) Early targeted intervention (nephroprotective hydration) if NGAL >50 ng/mL. The primary endpoint was the incidence of Acute Kidney Injury (AKI) defined by KDIGO criteria. Secondary endpoints included admission to the Intensive Care Unit (ICU) and duration of hospital stay. Results: The incidence of AKI was significantly lower in the Intervention Group compared to the Control Group (3.3% vs. 11.7%; p=0.015). In the Intervention Group, 18 patients were identified as "NGAL-positive" despite normal serum creatinine; early aggressive fluid resuscitation in this subgroup successfully prevented progression to clinical AKI in 94% of cases. The use of the digital app resulted in higher adherence to prescribed rehydration volumes (92% vs. 74% in controls). Consequently, the rate of transfer to the ICU for shock/instability was reduced by 60% in the Intervention Group (p=0.04). Conclusion: The integration of innovative diagnostic tools (uNGAL) and digital monitoring technologies allows for the detection of complications in the "pre-clinical" phase. This proactive strategy significantly reduces the incidence of renal injury and severe dehydration compared to traditional reactive management, supporting the adoption of precision medicine approaches in infectious disease wards.

Acute Intestinal Infections (AII), complications, Acute Kidney Injury (AKI), NGAL biomarker, precision medicine, digital health, dehydration, prevention, pediatric gastroenteritis.

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