Advanced Search
ORIGINAL ARTICLE
Korean J Pediatr 2012 August;55(8) :286-292.
Published online 2012 August 15.        doi:https://doi.org/10.3345/kjp.2012.55.8.286
Continuous renal replacement therapy in neonates weighing less than 3 kg
Young Bae Sohn (Sohn YB)1, Kyung Hoon Paik (Paik KH)1, Hee Yeon Cho (Cho HY)1, Su Jin Kim (Kim SJ)2, Sung Won Park (Park SW)1, Eun Sun Kim (Kim ES)1, Yun Sil Chang (Chang YS)1, Won-Soon Park (Park WS)1, Yoon-Ho Choi (Choi YH)3, Dong-Kyu Jin (Jin DK)1
1Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Department of Pediatrics, Myongji Hospital, Kwandong University College of Medicine, Goyang, Korea
3Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Corresponding Author: Dong-Kyu Jin ,Tel: +82-2-3410-3539, Fax: +82-2-3410-0043, Email: jindk@skku.edu
Copyright © 2012 by The Korean Pediatric Society
ABSTRACT
Purpose: Continuous renal replacement therapy (CRRT) is becoming the treatment of choice for supporting critically ill pediatric patients. However, a few studies present have reported CRRT use and outcome in neonates weighing less than 3 kg. The aim of this study is to describe the clinical application, outcome, and complications of CRRT in small neonates. Methods: A retrospective review was performed in 8 neonatal patients who underwent at least 24 hours of pumped venovenous CRRT at the Samsung Medical Center in Seoul, Korea, between March 2007 and July 2010. Data, including demographic characteristics, diagnosis, vital signs, medications, laboratory, and CRRT parameters were recorded. Results: The data of 8 patients were analyzed. At the initiation of CRRT, the median age was 5 days (corrected age, 38+2 weeks to 23 days), and the median body weight was 2.73 kg (range, 2.60 to 2.98 kg). Sixty-two patient-days of therapy were reviewed; the median time for CRRT in each patient was 7.8 days (range, 1 to 37 days). Adverse events included electrolyte disturbances, catheter-related complications, and CRRTrelated hypotension. The mean circuit functional survival was 13.98.6 hours. Overall, 4 patients (50%) survived; the other 4 patients, who developed multiorgan dysfunction syndrome, died. Conclusion: The complications of CRRT in newborns are relatively high. However, the results of this study suggest that venovenous CRRT is feasible and effective in neonates weighing less than 3 kg under elaborate supportive care. Furthermore, for using potential benefit of CRRT in neonates, efforts are required for prolonging filter survival.
Keywords: Critical illness | Infant | Renal replacement therapy | Treatment outcome
 
REFERENCE
1. Warady BA, Bunchman T. Dialysis therapy for children with acute renal failure: survey results. Pediatr Nephrol 2000;15:11–13.
2. Symons JM, Brophy PD, Gregory MJ, McAfee N, Somers MJ, Bunchman TE, et al. Continuous renal replacement therapy in children up to 10 kg. Am J Kidney Dis 2003;41:984–989.
3. Goldstein SL, Somers MJ, Baum MA, Symons JM, Brophy PD, Blowey D, et al. Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int 2005;67:653–658.
4. Warady BA, Schaefer FS, Fine RN, Alexander SR. Pediatric dialysis. Dordrecht: Kluwer Academic Publishers; 200
5. Walters S, Porter C, Brophy PD. Dialysis and pediatric acute kidney injury: choice of renal support modality. Pediatr Nephrol 2009;24:37–48.
6. Bellomo R, Ronco C. Continuous haemofiltration in the intensive care unit. Crit Care 2000;4:339–345.
7. Ronco C, Bonello M, Bordoni V, Ricci Z, D'Intini V, Bellomo R, et al. Extracorporeal therapies in non-renal disease: treatment of sepsis and the peak concentration hypothesis. Blood Purif 2004;22:164–174.
8. Jouvet P, Jugie M, Rabier D, Desgres J, Hubert P, Saudubray JM, et al. Combined nutritional support and continuous extracorporeal removal therapy in the severe acute phase of maple syrup urine disease. Intensive Care Med 2001;27:1798–1806.
9. Thompson GN, Butt WW, Shann FA, Kirby DM, Henning RD, Howells DW, et al. Continuous venovenous hemofiltration in the management of acute decompensation in inborn errors of metabolism. J Pediatr 1991;118:879–884.
10. Ponikvar R, Kandus A, Urbancic A, Kornhauser AG, Primozic J, Ponikvar JB. Continuous renal replacement therapy and plasma exchange in newborns and infants. Artif Organs 2002;26:163–168.
11. Bonilla-Felix M. Peritoneal dialysis in the pediatric intensive care unit setting. Perit Dial Int 2009;29 Suppl 2:S183–S185.
12. Teehan GS, Liangos O, Jaber BL. Update on dialytic management of acute renal failure. J Intensive Care Med 2003;18:130–138.
13. Westrope C, Morris K, Burford D, Morrison G. Continuous hemofiltration in the control of neonatal hyperammonemia: a 10-year experience. Pediatr Nephrol 2010;25:1725–1730.
14. Schaefer F, Straube E, Oh J, Mehls O, Mayatepek E. Dialysis in neonates with inborn errors of metabolism. Nephrol Dial Transplant 1999;14:910–918.
15. Ronco C, Parenzan L. Acute renal failure in infancy: treatment by continuous renal replacement therapy. Intensive Care Med 1995;21:490–499.
16. Reeves JH, Butt WB, Sathe AS. A review of venovenous haemofiltration in seriously ill infants. J Paediatr Child Health 1994;30:50–54.
17. Jaing TH, Hsueh C, Tain YL, Hung IJ, Hsia SH, Kao CC. Tumor lysis syndrome in an infant with Langerhans cell histiocytosis successfully treated using continuous arteriovenous hemofiltration. J Pediatr Hematol Oncol 2001;23:142–144.
18. Schröder CH, Severijnen RS, Potting CM. Continuous arteriovenous hemofiltration (CAVH) in a premature newborn as treatment of overhydration and hyperkalemia due to sepsis. Eur J Pediatr Surg 1992;2:368–369.
19. Picca S, Dionisi-Vici C, Abeni D, Pastore A, Rizzo C, Orzalesi M, et al. Extracorporeal dialysis in neonatal hyperammonemia: modalities and prognostic indicators. Pediatr Nephrol 2001;16:862–867.
20. Leyh RG, Notzold A, Kraatz EG, Sievers HH, Bernhard A. Continuous venovenous haemofiltration in neonates with renal insufficiency resulting from low cardiac output syndrome after cardiac surgery. Cardiovasc Surg 1996;4:520–525.
21. Jouvet P, Poggi F, Rabier D, Michel JL, Hubert P, Sposito M, et al. Continuous venovenous haemodiafiltration in the acute phase of neonatal maple syrup urine disease. J Inherit Metab Dis 1997;20:463–472.
22. Goldstein B, Giroir B, Randolph A. International Consensus Conference on Pediatric Sepsis. International pediatric sepsis consensus conference: definitions for sepsis and organ dysfunction in pediatrics. Pediatr Crit Care Med 2005;6:2–8.
23. Pollack MM, Patel KM, Ruttimann UE. PRISM III: an updated Pediatric Risk of Mortality score. Crit Care Med 1996;24:743–752.
24. Ronco C, Davenport A, Gura V. The future of the artificial kidney: moving towards wearable and miniaturized devices. Nefrologia 2011;31:9–16.
25. Maclaren G, Butt W. Controversies in paediatric continuous renal replacement therapy. Intensive Care Med 2009;35:596–602.
26. Santiago MJ, Lopez-Herce J, Urbano J, Solana MJ, del Castillo J, Ballestero Y, et al. Complications of continuous renal replacement therapy in critically ill children: a prospective observational evaluation study. Crit Care 2009;13:R184.
27. Choi G, Gomersall CD, Tian Q, Joynt GM, Freebairn R, Lipman J. Principles of antibacterial dosing in continuous renal replacement therapy. Crit Care Med 2009;37:2268–2282.
28. del Castillo J, Lopez-Herce J, Cidoncha E, Urbano J, Mencia S, Santiago MJ, et al. Circuit life span in critically ill children on continuous renal replacement treatment: a prospective observational evaluation study. Crit Care 2008;12:R93.
29. Goldstein SL, Hackbarth R, Bunchman TE, Blowey D, Brophy PD. Prospective Pediatric Crrt Registry Group Houston. Evaluation of the PRISMA M10 circuit in critically ill infants with acute kidney injury: a report from the Prospective Pediatric CRRT Registry Group. Int J Artif Organs 2006;29:1105–1108.
30. Monchi M, Berghmans D, Ledoux D, Canivet JL, Dubois B, Damas P. Citrate vs. heparin for anticoagulation in continuous venovenous hemofiltration: a prospective randomized study. Intensive Care Med 2004;30:260–265.
31. Kreuzer M, Ahlenstiel T, Kanzelmeyer N, Ehrich JH, Pape L. Management of regional citrate anticoagulation in pediatric high-flux dialysis: activated coagulation time versus post-filter ionized calcium. Pediatr Nephrol 2010;25:1305–1310.
32. Brophy PD, Somers MJ, Baum MA, Symons JM, McAfee N, Fortenberry JD, et al. Multi-centre evaluation of anticoagulation in patients receiving continuous renal replacement therapy (CRRT). Nephrol Dial Transplant 2005;20:1416–1421.
33. Bunchman TE, Maxvold NJ, Barnett J, Hutchings A, Benfield MR. Pediatric hemofiltration: Normocarb dialysate solution with citrate anticoagulation. Pediatr Nephrol 2002;17:150–154.
34. Ricci Z, Guzzo I, Picca S, Picardo S. Circuit lifespan during continuous renal replacement therapy: children and adults are not equal. Crit Care 2008;12:178.
35. Hahn H, Park YS. Regional citrate anticoagulation for continuous renal replacement therapy in children. J Korean Soc Pediatr Nephrol 2005;9:76–82.
36. Shin JA, Choi YS, Jung HW, Lee YJ, Kang NR, Yang S, et al. Regional citrate anticoagulation in continuous venovenous hemodiafiltration: report of two cases. Korean J Nephrol 2006;25:447–451.
37. Park JS, Kim GH, Kang CM, Lee CH. Regional anticoagulation with citrate is superior to systemic anticoagulation with heparin in critically Ill patients undergoing continuous venovenous hemodiafiltration. Korean J Intern Med 2011;26:68–75.
38. Tolwani AJ, Wille KM. Anticoagulation for continuous renal replacement therapy. Semin Dial 2009;22:141–145.
39. Inagaki O, Nishian Y, Iwaki R, Nakagawa K, Takamitsu Y, Fujita Y. Adsorption of nafamostat mesilate by hemodialysis membranes. Artif Organs 1992;16:553–558.
40. McBryde KD, Kershaw DB, Bunchman TE, Maxvold NJ, Mottes TA, Kudelka TL, et al. Renal replacement therapy in the treatment of confirmed or suspected inborn errors of metabolism. J Pediatr 2006;148:770–778.
TOOLS
PDF Links  PDF Links
Full text via DOI  Full text via DOI
  via Pubmed
Full text via PMC  Full text via PMC
via Pubreader  via PubReader
Download Citation  Download Citation
Supplementary Material  Supplementary Material
  E-Mail
Share:      
METRICS
1,475
View
12
Download
Acute treatment of hyperammonemia by continuous renal replacement therapy in a newborn patient with ornithine transcarbamylase deficiency  2011 October;54(10)
Outcome of Continuous Renal Replacement Therapy in Children  2005 January;48(1)
Continuous Renal Replacement Therapy in Pediatrics  2004 January;47(1)
Register for e-submission
Register here to access the e-submission system of Korean J Pediatr for authors and reviewers.
Manuscript Submission
To submit a manuscript, please visit the Korean J Pediatr e-submission management system at http://submit.kjp.or.kr, read the Instructions for Authors, and log into the Korean J Pediatr e-submission system. For assistance with manuscript submission, please contact: kjpped@gmail.com.
Free archive
Anyone may access any past or current articles without logging in.
Korean Pediatric Society Office
#1606, Seocho World Officetel, 19 Seoun-ro, Seocho-gu, Seoul 137-070, Korea
TEL : +82-2-3473-7305    FAX : +82-2-3473-7307   E-mail: kjpped@gmail.com
BrowseCurrent IssueFor Authors and ReviewersAbout
Copyright© The Korean Pediatric Society. All right reserved.