Postoperative Prophylactic Peritoneal Dialysis in Neonates and Infants After Complex Congenital Cardiac Surgery

Abstract

Peritoneal dialysis after complex congenital cardiac surgery was introduced to a group of neonates and infants (n = 756; age, 0 to 1 year) between May 1993 and December 2005. Indications of peritoneal dialysis were determined as well as methods, prolonged dialysis, and its outcomes. Demographic characteristics, preoperative risk factors, intraoperative variables, and postoperative complications were compared in 756 cases with ages below 1 year. All cases underwent ultrafiltration during the perioperative stage. One hundred eighty-six cases (24.6% of total) required peritoneal dialysis. The cardiac pathology was transposition of great arteries in 133 cases, tetralogy of Fallot in 37, aorticopulmonary window associated with interrupted aortic arch in 4 and total anomalous pulmonary venous return in 5, and other complex pathology in 7 cases. Prolonged peritoneal dialysis was usually required in infants with low weight, with episodes of pulmonary hypertensive crisis (p < 0.05), and with preoperative renal dysfunction. No major complication was observed related to the peritoneal dialysis catheter. Of 186 patients, 23 (12.3%) had acute renal failure, and 4 of them died (2.15% of all patients underwent operation, 17.3% of those with acute renal failure). It has been demonstrated that the combination of peritoneal dialysis with perioperative ultrafiltration application was effective in providing the required postoperative negative fluid balance in especially complex congenital heart cases and affected survival positively.

Early Initiation of Peritoneal Dialysis after Arterial Switch Operations in Newborn Patients

“…14,19 Most of the complications of PD are minor and easily manageable. 9,10,15 The complications of PD detected in this study were similar to those seen in other reports, consisting primarily of infection and catheter malfunction. 24,25 The reported complications in catheter functioning are around 30%, nearly 2% being major complications, of the catheters inserted in their pediatric patients which is nearly identical with our cohort (30.3%).…”

“…The glomerular filtration rate is reduced in newborns compared with that of older infants. 9,10 Renal vascular resistance is high with correspondingly elevated circulating renin levels. Hormonal responses to volume loading including atrial natriuretic factor may also be limited in the newborn.…”

“…All of these conditions render the neonate more prone to complications of ischemia than the older infant or child. 9 After complicated operations with long CPB times such as ASO, there is a high incidence of ARF. 7 Clinically, CPB is associated with a capillary leak syndrome, resulting in hypovolemia, and renal hypoperfusion.…”

Lesão renal aguda em crianças: incidência e fatores prognósticos em pacientes gravemente enfermos

“…The difference on AKI incidence in adult or pediatric patients following heart surgery is due to the more complex surgeries for congenital defects corrections. Alkan et al (29) describe that younger patients, more complex cardiac defects, longer extracorporeal circulation, and lower heart output are risk factors for AKI. In this context, they propose using a prophylactic PD catheter in newborns or infants undergoing complex heart surgery.…”

Diabetic ketoacidosis with acute kidney injury in prepubertal children: a report on two cases

“…37 Alkan et al and Flynn reported that Peritoneal dialysis remains an effective modality for the management of pediatric AKI. 38,39 Complications of PD include bladder and bowel perforation, along with bleeding issues related to the procedure. 8 Peritonitis was not seen in our patients.…”