Continuous Renal Replacement Therapy in Preterm Infants

Abstract

PurposeDespite the increasing use of continuous renal replacement therapy (CRRT) in the neonatal intensive care unit (NICU), few studies have investigated its use in preterm infants. This study evaluated the prognosis of preterm infants after CRRT and identified risk factors of mortality after CRRT.Materials and MethodsA retrospective review was performed in 33 preterm infants who underwent CRRT at the NICU of Samsung Medical Center between 2008 and 2017. Data of the demographic characteristics, predisposing morbidity, cardiopulmonary function, and CRRT were collected and compared between surviving and non-surviving preterm infants treated with CRRT. Univariable and multivariable analyses were performed to identify factors affecting mortality.ResultsCompared with the survivors, the non-survivors showed younger gestational age (29.3 vs. 33.6 weeks), lower birth weight (1359 vs. 2174 g), and lower Apgar scores at 1 minute (4.4 vs. 6.6) and 5 minutes (6.5 vs. 8.6). At the initiation of CRRT, the non-survivors showed a higher incidence of inotropic use (93% vs. 40%, p=0.017) and fluid overload (16.8% vs. 4.0%, p=0.031). Multivariable analysis revealed that fluid overload >10% at CRRT initiation was the primary determinant of mortality after CRRT in premature infants, with an adjusted odds ratio of 14.6 and a 95% confidence interval of 1.10–211.29.ConclusionOur data suggest that the degree of immaturity, cardiopulmonary instability, and fluid overload affect the prognosis of preterm infants after CRRT. Preventing fluid overload and earlier initiation of CRRT may improve treatment outcomes.

Continuous renal replacement therapy rescued life-threatening capillary leak syndrome in an extremely-low-birth-weight premature: a case report

“…Siddall, E et al [1] suggested that anasarca and AKI with oliguria were indications for CRRT support. In the study of Noh ES et al [11], the most common cause for CRRT in preterm infants were sepsis, necrotizing enterocolitis and inborn error of metabolism. Only 15% (5/ 33) of the preterm who received CRRT in the NICU survived.…”

Optimal stage of initiating continuous renal replacement therapy in the treatment of neonatal acute kidney injury

“…CRRT can accurately control neonatal blood volume via continuous, slow, and gradual control, which maintains fluid balance and hemodynamic stability (24). Neonates, notably premature infants, exhibit reduced blood volume and difficulty in vascular catheterization (25). Therefore, the developers of the blood purification equipment had limited power to develop specific CRRT filters for neonates, and the CRRT method was restricted from newborns for a long time period (26).…”

A Case Series: Continuous Kidney Replacement Therapy in Neonates With Low Body Weight

“…However, there are many challenges in the application of CKRT on neonates with low body weights, including adequate circuit life span and the prevention of intradialytic hypotension. Although some previous reports have described the use of CKRT in infants with variable body weights, these earlier studies did not focus on the specific management and clinical outcomes of neonates with low body weight ( Supplementary Table 1 ) ( 8 – 13 ). In this report, we describe three neonates with low body weights that were successfully treated with CKRT using our modified protocols ( Figure 2 ).…”

“…Continuous KRT (CKRT) may represent a suitable alternative. However, very few studies have investigated the application of CKRT in neonates with low body weights (<2.5 kg) (8)(9)(10)(11)(12)(13) (Supplementary Table 1). In this report, we discuss our experiences of three neonates with a low birth weight who were treated with CKRT at a tertiary medical center in southern Taiwan.…”