Complications During Continuous Renal Replacement Therapy in Critically Ill Neonates

Nishimi, Saeko; Sugawara, Hiroshi; Onodera, Chinatsu; Toya, Yukiko; Furukawa, Hiromi; Konishi, Yu; Sotodate, Genichiro; Matsumoto, Atsushi; Ishikawa, Ken; Oyama, Kotaro

doi:10.1159/000496654

Cited by 15 publications

(10 citation statements)

References 24 publications

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“…The average weight of newborns in the current study was 3 kg, and the extracorporeal circulation volume was about 1/3–1/4 of the newborns’ total blood volume. In addition, thrombocytopenia was observed in the CRRT sessions, which increases the risk of bleeding ( 17 ). The decrease in platelet count can be attributed to platelet activation and degranulation from exposure to the roller pump in the CRRT machine and by attaching with the microbubbles or dialysate ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Regional citrate anticoagulation for continuous renal replacement therapy in newborns

Huang

Xing²,

Bai³

et al. 2023

Front. Pediatr.

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BackgroundRegional citrate anticoagulant (RCA) is recommended as the preferred anticoagulant regimen for continuous renal replacement therapy (CRRT) in adults; however, it is rarely reported in neonates due to concerns associated with their immature liver. Few studies have reported on the use of RCA to evaluate the safety and efficacy of RCA-CRRT in neonates.MethodIn this retrospective observational study, we reviewed the clinical records of neonates who underwent RCA-CRRT at our pediatric intensive care unit between September 2015 to January 2021.ResultsA total of 23 neonates underwent 57 sessions of RCA-CRRT. Their mean age was 10.1 ± 6.9 days and mean weight was 3.0 ± 0.7 kg (range, 0.95–4 kg). The mean filter life was 31.54 ± 19.58 h (range, 3.3–72.5 h). Compared to pretreatment values, the total-to-ionized calcium ratio (T/iCa) on RCA-CRRT increased (2.00 ± 34 0.36 vs. 2.19 ± 0.40, P = 0.056) as did the incidence of T/iCa levels >2.5 (11.4 vs. 14.3, P = 0.477), albeit not significantly. Using a post-treatment T/iCa threshold of 2.5, we divided all the cases into citrate accumulation (CA) and non-CA (NCA) groups. Compared with the NCA group, the CA group had significantly higher body weight (3.64 ± 0.32 kg vs. 2.95 ± 0.41 kg, P = 0.033) and significantly lower blood flow rate per body weight ml/kg/min (3.08 ± 0.08 vs. 4.07 ± 0.71, P = 0.027); however, there was no significant difference between the two groups in terms of age, corrected gestational age, the PRISM-III score, and biochemical tests.ConclusionRCA-CRRT is safe and effective for neonates. After appropriate adjustments of the RCA-CRRT parameters, the incidence of CA was not higher in neonates than in children or adults, and CA was not found to be significantly correlated with age or corrected gestational age.

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Section: Discussionmentioning

confidence: 99%

Regional citrate anticoagulation for continuous renal replacement therapy in newborns

Huang

Xing²,

Bai³

et al. 2023

Front. Pediatr.

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“…paKST can be associated with significant clinical complications such as hypotension, hypothermia, bleeding, unplanned circuit loss, and thrombocytopenia [ 47 ]. Information on interventions that can be performed immediately before KST initiation to prevent undesirable events and avoid further compromise in an already fragile infant or child is sparse.…”

Section: Building Pediatric Acute Kidney Support Therapy Programsmentioning

confidence: 99%

Programs and processes for advancing pediatric acute kidney support therapy in hospitalized and critically ill children: a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference

Neumayr,

Bayrakci,

Chanchlani

et al. 2023

Pediatr Nephrol

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Pediatric acute kidney support therapy (paKST) programs aim to reliably provide safe, effective, and timely extracorporeal supportive care for acutely and critically ill pediatric patients with acute kidney injury (AKI), fluid and electrolyte derangements, and/or toxin accumulation with a goal of improving both hospital-based and lifelong outcomes. Little is known about optimal ways to configure paKST teams and programs, pediatric-specific aspects of delivering high-quality paKST, strategies for transitioning from acute continuous modes of paKST to facilitate rehabilitation, or providing effective short- and long-term follow-up. As part of the 26th Acute Disease Quality Initiative Conference, the first to focus on a pediatric population, we summarize here the current state of knowledge in paKST programs and technology, identify key knowledge gaps in the field, and propose a framework for current best practices and future research in paKST.

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“…Continuous extracorporeal blood purification or intermittent haemodialysis can be performed in neonates by using adult devices, 4,13,20‐22 but in most cases extracorporeal volume exceeds the threshold of 10%‐15% of the neonate's blood volume, ranging from 45 to 93ml, depending on the manufacturer (Table 3). If extracorporeal volume is more than 10%‐15% of total blood volume, the circuit should be primed with packed red blood cells 23 .…”

Section: Dialysis Modalitiesmentioning

confidence: 99%

Review: Neonatal dialysis is technically feasible but ethical and global issues need to be addressed

et al. 2020

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Aim Our aim was to look at the technical, ethical and global issues related to neonatal dialysis. Methods We performed a PubMed research on manuscripts published from March 2010 to March 2020 and retrospectively reviewed all neonates who received dialysis in our French paediatric and neonatal intensive care units from April 2009 to March 2019. Results Dialysis is performed on neonates with pre‐existing renal diseases, acute kidney injuries or inborn errors of metabolism. It is required in 0.5%‐1% of neonates admitted to the neonatal intensive care units. Peritoneal dialysis and extracorporeal blood purification are both feasible, with more complications, but the results are close to those obtained in older infants, at least in children without multi‐organ dysfunction. Novel haemodialysis machines are being evaluated. Ethical issues are a major concern. Multidisciplinary teams should consider associated comorbidities, risks of permanent end‐stage renal disease and provide parents with full and neutral information. These should drive decisions about whether dialysis is in child's best interests. Conclusion Neonatal dialysis is technically feasible, but ethically challenging, and short‐term and long‐term data remain limited. Prospective studies and dialysis registries would improve global management and quality of life of these patients at risk of chronic kidney disease.

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Complications During Continuous Renal Replacement Therapy in Critically Ill Neonates

Cited by 15 publications

References 24 publications

Regional citrate anticoagulation for continuous renal replacement therapy in newborns

Regional citrate anticoagulation for continuous renal replacement therapy in newborns

Programs and processes for advancing pediatric acute kidney support therapy in hospitalized and critically ill children: a report from the 26th Acute Disease Quality Initiative (ADQI) consensus conference

Review: Neonatal dialysis is technically feasible but ethical and global issues need to be addressed

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