Continuous venovenous haemofiltration in neonates

Objective

To review our experience of continuous venovenous haemofiltration (CVVH) in neonates requiring renal replacement therapy.

Methods

Twenty-two neonates who received CVVH between September 1997 and September 2002 were retrospectively identified and the following data extracted from their records: age, gestation, body weight diagnosis, number of failed organs, indication for renal replacement therapy (RRT) and site and nature of vascular access. Additionally, we recorded the maximum haemofilter blood flow, mean filter life and complications associated with achieving vascular access or running CVVH.

Results

Twenty-two neonates received CVVH, either as the sole form of RRT (18 patients) or on the abandonment of PD (four patients). The median gestational age was 37 weeks (range 34–40 weeks). Patient weight ranged from 2.3 to 4.7 kg (median 2.7 kg). In 18 cases CVVH was initiated for a combination of acidaemia, fluid overload and electrolyte disturbance. In three cases metabolic acidaemia secondary to an inborn error of metabolism was the indication. In one case fluid overload alone triggered therapy. The median number of failed organs was three (range 2–5). Venous access was achieved via the femoral vein in 12 cases, the subclavian in three cases, the internal jugular in six cases, and the umbilical vein in one case. Cannulation was achieved with 5 or 6.5 Fr double-lumen catheters. The median duration of CVVH was 47 hours (range 20–336 hours). A median of three filter changes were required per patient run (range 0–10) and the median filter life was 24 hours (range 30 min–145 hours). CVVH was complicated by haemothorax in one patient, profound hypotension on initiation of filter flow in one case and pericannula bleeding requiring infusion of coagulation products in one case. Each complication was rapidly corrected.

Conclusion

CVVH can be successfully initiated in the neonatal population with a low incidence of morbidity or technical difficulty.