Peritoneal Dialysis in an Extremely Low Birth Weight Neonate with Ileostomy

Abstract

Background Acute kidney injury (AKI) is a common complication in sick, extremely low birth weight (ELBW) neonates. Peritoneal dialysis (PD) is the treatment modality but is seldom attempted in this patient population. We present a 40-day-old ELBW neonate previously operated for necrotizing enterocolitis with ileostomy who developed AKI. Peritoneal dialysis was started by a modifying intercostal drain. Results Doing a simple procedure and using a few modifications helped the baby to come out of acute kidney injury. Conclusion Peritoneal dialysis can be technically quite challenging in ELBW neonates but is possible with certain innovative modifications. Key message Challenging technical problems in potentially fatal conditions sometimes respond to simple innovation. Initiation of early peritoneal dialysis in a sick ELBW with ileostomy and AKI helped saved her life. How to cite this article Kaul A, Jadhav K, Shah S. Peritoneal Dialysis in an Extremely Low Birth Weight Neonate with Ileostomy. Indian J Crit Care Med 2019;23(5):232–233.

Peritoneal Dialysis in Micro-preemie With NEC Using Pigtail Catheter: Case Report and Literature Review

“…There are several case reports in preterm infants with AKI and PD 3,10,11 but only a few on PD in NEC infants with AKI. [1][2][3] Canpolat et al reported four cases of NEC with perforation who underwent primary peritoneal drainage (PPD) followed by PD for AKI with a 75% mortality rate. 1 Amita et al reported a case of NEC with ileostomy that later underwent PD for AKI with recovery.…”

“…1 Amita et al reported a case of NEC with ileostomy that later underwent PD for AKI with recovery. 2 Okan et al reported a 75% mortality rate among ELBW with NEC who underwent PD. 3 In addition to high mortality rates due to underlying primary pathology, the literature describes high rates of complications related to a lack of size-specific catheters in ELBWs, and catheter leak and peritonitis are common problems.…”

“…1 Amita et al reported a case of NEC with ileostomy that later underwent PD for AKI with recovery. 2 Okan et al reported a 75% mortality rate among ELBW with NEC who underwent PD. 3…”

“…There are a few case reports from India on PD in NEC, where Amita et al reported that ELBW neonates underwent PD with NEC and ileostomy. [1][2][3] Various studies report the use of a variety of PD dialyzing catheters in ELBW babies. To the author's best knowledge, the use of pigtail catheters for PD has not been described.…”

Peritoneal dialysis patient selection from a comorbidity perspective

“…In the literature, there is only a case of a newborn baby with acute kidney injury and ileostomy due to necrotizing enterocolitis who was successfully treated with PD. 116 Otherwise there are several reports on use of percutaneous endoscopic gastrostomy (PEG) in children receiving peritoneal dialysis (PD). The use of gastrostomy tubes in children treated with PD is to allow adequate enteral nutrition.…”