Managing acute renal failure in very low birthweight infants.

Coulthard, Malcolm; Vernon, B G

doi:10.1136/fn.73.3.f187

Cited by 54 publications

(51 citation statements)

References 43 publications

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“…The biochemical parameters of our patients were compatible with intrinsic renal failure with acute tubular necrosis (ATN), and the overall mortality rate was 37.5%, which is lower than has been reported in prior reviews [3,4,6,10,11]. In conclusion, early APD was performed successfully even in very small neonates.…”

Section: Discussionsupporting

confidence: 50%

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Acute peritoneal dialysis in very low birth weight neonates using a vascular catheter

Park

Pai

2010

Pediatr Nephrol

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We report on our experience with acute peritoneal dialysis (APD) in 16 very low birth weight neonates ranging from 24.6 to 30.2 weeks' gestation with a birth weight ranging from 630 g to 1,430 g using a 14-gauge Arrow vascular catheter for APD access. The underlying causes of acute renal failure were: sepsis (7), necrotizing enterocolitis (4), patent ductus arteriosus (3), hydrops fetalis (1), intracranial hemorrhage (3), pulmonary hemorrhage (2), pneumonia (1), and perinatal asphyxia (1). Among 12 patients, the APD was successful for the control of hyperkalemia, fluid overload, and metabolic acidosis. The peritoneal permeability and transport were at their maximum at a short dwell time with rapid exchanges. Complications associated with the APD were: peritonitis (2), leakage (2), hemoperitoneum (1), and hernia (1). During the dialysis, four patients died; there were three episodes of catheter-related complications in these patients. At 60 days after the withdrawal of the APD, 10 patients were alive, and had full recovery of their renal function. Therefore, APD in premature neonates with a 14-gauge Arrow vascular catheter was safe and effective. This procedure helped manage the hemodynamic and metabolic imbalance of acute renal failure and was associated with few complications.

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Section: Discussionsupporting

confidence: 50%

“…However, mortality is still high in preterm infants with oliguric ARF. In addition, abnormalities in the glomerular filtration and tubular function can persist in infants following acute kidney injury [4,6,10,11].…”

Section: Discussionmentioning

confidence: 99%

Acute peritoneal dialysis in very low birth weight neonates using a vascular catheter

Park

Pai

2010

Pediatr Nephrol

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“…Hyperkalemia unresponsive to medical management is one of the most common indications for renal replacement therapy in the newborn [24,43].…”

Section: Electrolyte and Mineral Homeostasismentioning

confidence: 99%

Acute Kidney Injury in the Newborn

Askenazi

2013

Kidney and Urinary Tract Diseases in the Newborn

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“…Most cases are secondary to other medical conditions rather than inherent kidney disease [1]. If renal replacement becomes necessary, peritoneal dialysis is preferred [1], but sometimes this is not feasible.…”

Section: Introductionmentioning

confidence: 99%

A machine for haemodialysing very small infants

et al. 2005

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Babies weighing under 6 kg are difficult to dialyse, especially those as small as 1 kg. Peritoneal dialysis is easier than haemodialysis, but is not always possible, and clears molecules less efficiently. Two factors complicate haemodialysis. First, extracorporeal circuits are large relative to a baby's blood volume, necessitating priming with fresh or modified blood. Second, blood flow from infants' access vessels is disproportionately low (Poiseuille's law), causing inadequate dialysis, or clotting within the circuit. These problems are minimised by using single lumen access, a very small circuit, and a reservoir syringe to separate the sampling and dialyser blood flow rates. Its manual operation is tedious, so we developed a computer-controlled, pressure-monitored machine to run it, including adjusting the blood withdrawal rate from poorly sampling lines. We have dialysed four babies weighing 0.8-3.4 kg, with renal failure or metabolic disorders. The circuits did not require priming. Clearances of creatinine, urea, potassium, phosphate and ammonia were mean (SD) 0.54 (0.22) ml/min using one dialyser, and 0.98 (0.22) ml/min using two in parallel. Ammonia clearance in a 2.4 kg baby had a 9 h half-life. Ultrafiltration up to 45 ml/h was achieved easily. This device provided infants with immediate, effective and convenient haemodialysis, typically delivered for prolonged periods.

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Managing acute renal failure in very low birthweight infants.

Cited by 54 publications

References 43 publications

Acute peritoneal dialysis in very low birth weight neonates using a vascular catheter

Acute peritoneal dialysis in very low birth weight neonates using a vascular catheter

Acute Kidney Injury in the Newborn

A machine for haemodialysing very small infants

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