Background Providing renal support for small children is very challenging using the machinery currently available in the United States. As the extra-corporeal volume (ECV) relative to blood volume increases, and the state of critical illness worsens, the chance for instability during continuous renal replacement therapy (CRRT) initiation rises. CRRT machines with smaller ECV could reduce the risks and improve outcomes. Methods 1) Case series of small children (n = 12) who received continuous veno-venous hemofiltration (CVVH) via Aquadex™ machine (ECV = 33 mL) with 30 mL/kg/h of pre-replacement fluids at Children’s of Alabama between December 2013 and April 2015. 2) In vitro assessment of fluid precision using the adapted CVVH system. Results We utilized 101 circuits over 261 days to provide CVVH for 12 children (median age = 30 days; median weight 3.4 kg). Median CVVH duration = 14.5 days (IQR = 10, 22.8 days). Most circuits were routinely stopped for change after 72 h. Only 5/101 (5 %) initiations were associated with mild transient change in vital signs. Complications were infrequent (three transient hypothermia; three puncture-site bleeding, one systemic bleeding, and one right atrial thrombus). Most patients (7/12, 58 %) were discharged from ICU, and 6/12 (50 %) were discharged home. Conclusions CRRT machines with low ECV can enable clinicians to provide adequate, timely, safe and efficient renal support to small critically ill infants.

The pharmacokinetic (PK) parameters of lisinopril were obtained in 46 children aged 6 months to 15 years. A lisinopril suspension (0.15 mg/kg per day) was administered to patients <6 years of age; the remaining children received lisinopril tablets, the daily dose being adjusted according to body weight, i.e., 2.5 mg if <25 kg, 5 mg if 25-45 kg, and 10 mg if >45 kg. Blood was drawn predose and on eight occasions postdose in children aged 4-15 years, and on five occasions in those aged <4 years. PK data are reported for the 46 children in terms of age groups: Group I (n=9), aged 6-23 months; Group II (n=8), aged 2-5 years; Group III (n=12), aged 6-11 years; Group IV (n=17), aged 12-15 years. The dose of lisinopril ranged from 3.07 mg/m(2) per day in Group I to 4.78 mg/m(2) per day in Group IV. C(max) of lisinopril, which occurred 5-6 h postdose, varied from 22 ng/ml in Groups I and II to 44 ng/ml in Groups III and IV; AUC(0-24 h) ranged from 301-311 ng.h/ml in Groups I and II to 550-570 ng.h/ml in Groups III and IV. No serious adverse events related to lisinopril were reported.