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Continuous renal replacement therapy in critically ill neonates

Objective

To describe our experience with continuous renal replacement therapy (CRRT) in critically ill neonates.

Design

Prospective case report series.

Setting

A 12 bed multidisciplinary pediatric ICU and a 14 bed neonatal ICU in a University hospital.

Patients

From June 1985 to June 1997 36 critically ill oliguric or anuric neonates underwent continuous arterio-venous (n = 17) or veno-venous (n = 15) renal support. Four neonates were treated with continuous ultrafiltration (CUF) during extracorporeal membrane oxygenation (ECMO). Their mean age was 9.8 ± 1.5 days, their mean body weight 3.01 ± 0.1 kg. All patients were mechanically ventilated and 88% needed vasopressor support. Indications for CRRT were: low cardiac output (n = 10), multiple organ system failure (n = 18), severe diuretic resistant hypervolemia (n = 3), and severe metabolic crisis (n = 5).

Methods

The membrane surface area of the hemofilters ranged from 0.015 to 0.2 m2 and the priming volume from 3.7 to 15 ml. For pump-driven hemofiltration a roller pump with pressure alarms, an air trap, an air bubble detector, and small blood lines was used. Fluid balance was controlled by a microprocessor controlled unit. The ultrafiltrate substitution fluid was based on bicarbonate and was partially or totally replaced according to the clinical situation.

Results

Mean duration of renal support was 97 ± 20 h, ranging from 14 to 720 h Operational data and survival rates during arteriovenous and veno-venous hemofiltration and continuous ultrafiltration during ECMO are given in Table 1.

Conclusion

Continuous hemofiltration either driven in the arteriovenous or veno-venous mode is a very effective method of renal support for critically ill neonates to control fluid balance and metabolic derangement. CUF can be easily performed during ECMO and should be started early in the presence of severe hypervolemia.

Table 1 Table 1

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Rödi, S., Zobel, G., Urlesberger, B. et al. Continuous renal replacement therapy in critically ill neonates. Crit Care 2, P129 (1998). https://doi.org/10.1186/cc258

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Keywords

  • Fluid Balance
  • Continuous Renal Replacement Therapy
  • Extracorporeal Membrane Oxygenation
  • Membrane Surface Area
  • Organ System Failure