Continuous Renal Replacement Therapy in the Neonatal Intensive Care Unit: A Single Center Study
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Purpose: Continuous renal replacement therapy (CRRT) has become an essentialmodality for the care of critically ill pediatric patients who require renal support. However, experience with CRRT in the neonatal population is not common in Korea. In this study, we aimed to investigate the clinical features, outcomes, and complicationsof CRRT in neonates in a single neonatal intensive care unit (NICU). Methods: We reviewed the medical records of 17 neonates who underwent CRRT at aNICU of a tertiary hospital. The data included demographic characteristics, diagnosis,complications, and laboratory and CRRT parameters. Results: The median age at initiation of CRRT was 6 days after birth. All patients weretreated with CRRT in continuous venovenous hemodiafiltration mode, with a mediantreatment duration of 57 hours. The main indication for CRRT was an inborn error ofmetabolism (IEM), followed by congenital renal disease and multiorgan failure. Inpatients with an IEM, the median plasma ammonia level at the CRRT initiation was1,232 μmol/L, and the mean duration until the ammonia level decreased to half of thepeak ammonia level was 7.3±2.5 hours. The overall hospital mortality rate was 41.2%. The outcomes of the 10 survivors after discharge included death (n=2), loss to followup(n=3), and survival with developmental delay (n=4). Conclusion: Although CRRT was effective in lowering the plasma ammonia level ofneonates with IEM, the associated mortality and morbidity were high. Hence, furtherstudies are needed to optimize the CRRT protocol and to establish an effective patientreferral system in Korea.
Abstract
Purpose: Continuous renal replacement therapy (CRRT) has become an essentialmodality for the care of critically ill pediatric patients who require renal support. However, experience with CRRT in the neonatal population is not common in Korea. In this study, we aimed to investigate the clinical features, outcomes, and complicationsof CRRT in neonates in a single neonatal intensive care unit (NICU). Methods: We reviewed the medical records of 17 neonates who underwent CRRT at aNICU of a tertiary hospital. The data included demographic characteristics, diagnosis,complications, and laboratory and CRRT parameters. Results: The median age at initiation of CRRT was 6 days after birth. All patients weretreated with CRRT in continuous venovenous hemodiafiltration mode, with a mediantreatment duration of 57 hours. The main indication for CRRT was an inborn error ofmetabolism (IEM), followed by congenital renal disease and multiorgan failure. Inpatients with an IEM, the median plasma ammonia level at the CRRT initiation was1,232 μmol/L, and the mean duration until the ammonia level decreased to half of thepeak ammonia level was 7.3±2.5 hours. The overall hospital mortality rate was 41.2%. The outcomes of the 10 survivors after discharge included death (n=2), loss to followup(n=3), and survival with developmental delay (n=4). Conclusion: Although CRRT was effective in lowering the plasma ammonia level ofneonates with IEM, the associated mortality and morbidity were high. Hence, furtherstudies are needed to optimize the CRRT protocol and to establish an effective patientreferral system in Korea.
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