Effects of different techniques of peritoneal dialysis at the intra-abdominal pressure in a newborn

Abstract

Introduction. Peritoneal dialysis (PD) is considered a very effective care for newborns with severe acute renal injury , and it is a method of choice for treating newborns in the end-stage renal failure who require chronic renal replacement therapy (RRT). The classical modification of peritoneal dialysis involves the introduction of dialysis solution into the abdominal cavity, its presence there for a certain time (exposure time) and its passive evacuation from the abdominal cavity. However, this technique of peritoneal dialysis causes an increased intra-abdominal pressure leading to a number of complications. PD in premature newborns, including those with extremely low body weight, has a number of features associated with extremely immature organs and tissues. One more problem is hemodynamic instability in this category of patients. Besides, peritoneal dialysis in the classical modification accompanied by increase in the intra-abdominal pressure can cause hemodynamic and respiratory disorders. The purpose of this article is to demonstrate the effect of the modified peritoneal dialysis, developed by the authors, at the intraabdominal pressure and compare it with the classical approach.Material and methods. A method of flow peritoneal dialysis in premature newborns has been developed, which significantly reduces the effect of peritoneal dialysis at the intra-abdominal pressure. Intra-abdominal pressure monitoring was performed using the invasive low pressure meter IInd 500/75 Triton. The values of intra-abdominal pressure in children receiving renal replacement therapy with various modifications of peritoneal dialysis were compared.Results. Our observations show that peritoneal dialysis in the flow modification avoids sharp fluctuations in intra-abdominal pressure. Conclusion. In our opinion, flow modification of peritoneal dialysis may be the method of choice for replacement therapy in deeply premature infants with low and extremely low birth weight.