Neonatal Sepsis with Multi-Organ Failure and Treated with a New Dialysis Device Specifically Designed for Newborns

Abstract

Neonatal sepsis due to E. coli is often complicated by multiple organ failure (MOF) and a high mortality risk. We report the case of a term newborn discharged in good condition who suddenly fell into septic shock after 11 days and required immediate resuscitation, volume expansion and a high-dosage amine infusion. Extremely severe metabolic acidosis, disseminated intravascular coagulation (DIC) with diffuse bleeding, and unstable hemodynamic status with oliguria turned into strict anuria, and the patient became anuric. The presence of DIC, with gastric and intestinal bleeding, rendered peritoneal dialysis impossible. Continuous renal replacement therapy (CRRT) was started with the new dialysis machine CARPEDIEM® (Cardio-Renal Pediatric Dialysis Emergency Machine), available on a trial-basis in our center, after the surgical placement of jugular double-lumen central venous catheters. A ‘ready to use' neonatal kit with a low-priming volume of the extracorporeal circuit allowed a prompt hemofiltration start. The filtration CRRT was continuously performed for 48 h, then intermittently (12 h/day) for 2 more days and interrupted on day 5 for diuresis reprisal. Acute kidney injury and multi-organ failure resolved after 5 days. The child survived without neurological damage, with a normal renal function and a normal development at 9 months follow-up. In conclusion, a prompt CRRT start with this specifically designed neonatal device allowed a progressive stabilization of hemodynamics, a better control of acidosis, a reduction of amine requirement, a gradual control of fluid overload and a rapid improvement of MOF, DIC as well as a resolution of the acute kidney injury. The device also allowed the extension of CRRT in the neonatal age.

Pediatric continuous renal replacement therapy: have practice changes changed outcomes? A large single-center ten-year retrospective evaluation

“…A specialized pediatric CRRT circuit, the PrismaFlex HF20, with an extracorpeal volume of 60 ml [ 26 ] is currently being tested for FDA approval at pediatric centers throughout the USA. CARPEDIEM is RRT equipment with a 27 ml extracorpeal circuit volume and capability to handle blood flow rates 5–50 ml/hr., that once approved should dramatically improve the mechanics of treating the smallest patients [ 27 , 28 ]. Additionally, the Newcastle infant dialysis and ultrafiltration system (NIDUS) is hemodialysis equipment designed for use in infants 800 g to 8 kg, without need for blood priming as well as using only single lumen vascular access, and successful use has been published on 9 babies weighing 1.8 kg to 5.9 kg in the United Kingdom [ 29 ].…”

Pediatric reference ranges for acute kidney injury biomarkers

“…Partly responsible for the increase is that diseases that previously had high fatality rates, such as sepsis, congenital heart disease, and certain cancers, have increased survival due to increased quality of care [4–6]. The functional consequence of AKI is reduced glomerular filtration rate.…”

Clinical effect and safety of continuous renal replacement therapy in the treatment of neonatal sepsis-related acute kidney injury

“…In this study, we found that after 24 h of CRRT, the levels of blood urea nitrogen and creatinine decreased significantly. In 2016, when the demand for metabolism and fluid management exceeds the capacity of kidney, which is called fluid overload, it should be treated as early as possible [24]. This means that when the metabolism and fluid management of sepsis-related AKI are beyond the renal capacity, (even without renal damage), CRRT should be initiated in time.…”