Challenges of acute peritoneal dialysis in extremely-low-birth-weight infants: a retrospective cohort study

Abstract

Background Peritoneal dialysis (PD) has been used occasionally in extremely-low-birth-weight (ELBW) infants with acute kidney injury (AKI). This study aimed to evaluate the clinical characteristics and outcomes of ELBW infants with AKI treated with PD. Methods In this retrospective cohort study, the medical records of ELBW infants with AKI, who underwent PD from January 2008 to February 2018, were reviewed. A PD catheter (7.5–9.0 Fr) or central venous catheter (4 Fr) was used for the peritoneal access. Treatment with PD solutions (2.5 or 4.25%) was started at 10 mL/kg, which was increased to 20–30 mL/kg for 60–120 min/cycle continuing for 24 h. Results Twelve ELBW infants (seven male and five female infants) were treated, and their mean (±SD) gestational age and birth weight were 27.2 (±3.3) weeks and 706.5 (±220.5) g, respectively. Two patients had severe perinatal asphyxia (5-min Apgar score ≤ 3). The most important indication for starting PD was AKI due to sepsis. The average (±SD) duration of PD was 9.4 (± 7.7) days. The potassium levels in the ELBW infants with hyperkalemia decreased from 6.8 to 5.0 mg/mL after 9.3 (± 4.4) days. The most common complication of PD was mechanical dysfunction of the catheters, such as dialysate leakage (75%). Two patients were successful weaned off PD. The mortality rate of the infants treated with PD was 91.7%. Conclusions In this series, the mortality rate of ELBW infants with AKI treated with PD was relatively high because of their incompletely developed organ systems. Therefore, the use of PD should be carefully considered for the treatment of ELBW infants with AKI in terms of decisions regarding resuscitation.

Intestinal prolapse and exposure after peritoneal dialysis in low-birth-weight preterm infants with acute renal failure: a case report

“…No special PD catheter has been developed for newborns of different weights. Some medical centers ( 4 - 6 ) use a central venous catheter as a PD catheter for infants since it has a small diameter and is relatively soft, which positively improves the prognosis and reduces the mortality rate among infants and children. However, in these case reports, the surgical incisions resulted in different degrees of PD solution leakage.…”

Peritoneal dialysis in very low and extremely low birthweight infants: A pooled analysis

“…39 Peritonitis rates may be decreased by the prophylactic use of antibiotics or antifungals, although the emergence of antibiotic-resistant strains limits the efficacy of this approach. 28 Omental adherence may predispose to catheter obstruction, requiring reoperation; however, routine omentectomy is not recommended due to the low risk of omental plugging given the short duration of acute PD. 47 Achieving effective ultrafiltration is of high importance and close monitoring is warranted, taking into account the distinctive properties of the neonatal peritoneal membrane.…”

“…Nonetheless, the choice of the appropriate catheter for preterm neonates is challenging due to technical difficulties associated with the small body mass and the decreased elasticity of the abdominal wall. 28 Tenckhoff catheters constitute the most widely used ones for PD of children and even neonates due to their biocompatible nature and their large-bore lumen and side holes, allowing reliable dialysate flow. 46 However, the insertion of acute PD catheters may be technically difficult in VLBW and ELBW infants due to their limited availability in appropriate sizes.…”

“…Of them, two studies 23,24 were excluded for not providing individual participant data and another one 25 was not included as the follow-up period was not available. As a result, the present meta-analysis was based on 20 studies, 26,27,[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] comprising 101 infants (27 VLBW and 74 ELBW).…”

TINKER-ing with neonatal acute kidney injury

“…Other studies report mechanical dysfunction, leakage, peritonitis, bleeding, rarely intestinal perforation and a high mortality (30-91%) among ELBW/VLBW neonates. [12][13][14] Novel approaches for safe and effective PD have proved successful in ELBW and VLBW neonates using modified catheter insertion techniques, intravenous cannulas, umbilical vein catheters and multifunctional flexible 8-10F catheters. [15][16][17][18][19] These novel PD systems using the Seldinger technique are costeffective compared to surgical insertion of Tenckhoff catheters.…”