Hemofiltration and Plasmapheresis in Premature Infants and Newborns

Abstract

Extracorporal detoxication methods in newborns are most unavailable, contraindicated because of technical problems. Herein are reported the experiences with a blood pump unit that was miniaturized for hemodialysis, hemofiltration, and plasmapheresis in newborns. In three premature infants with acute renal failure of different etiology (two newborns with severe Rh-erythroblastosis, 1 premature infant with hypoproteinemia) 13 single-needle hemofiltrations and 6 single-needle plasmaphereses were performed with double head pump, special tube systems, and small modules. The age of the patients ranged from 1 to 14 days, body weight was between 800 and 2,800 g. Four umbilical veins and two femoral veins were used as vascular access. The ultrafiltration rate during the treatment averaged 0.3 mumin in single-needle hemofiltration and the plasma filtrate flow rate 1.3 mllmin in single-needle plasmapheresis. All treatments were well tolerated. Four patients died due to complications unrelated to the treatment, two patients recovered. These preliminary results show that both hemofiltration and plasmapheresis may be carried out without major problems in premature infants and newborns.

Therapeutic Plasma Exchange—Does Age Matter? A Single‐Center Study

“…Additionally, the equipment used for TPE is designed for adult patients and generally has extracorporeal blood volumes greater than 200 mL. In very small children, these relatively large extracorporeal blood volumes can result in hemodynamic imbalance; consequently, the TPE procedure often has to be modified (see Patients and Methods) (2)(3)(4)(5)(6)(7)(8). Elderly patients are also more prone to developing complications due to concomitant diseases, polymedication, and vulnerable hemodynamic systems (9,10).…”

Successful therapeutic plasma exchange in a 3.2‐kg body weight neonate with atypical hemolytic uremic syndrome

“…TPE in extremely low body weight infants has no consensus on the absolute indication unlike adults and older children. Although younger age was not a risk factor for adverse events in the TPE procedure, it is a complex process having various technical difficulties including problems related to vascular access, hemodynamic instability, infections, acute volume overload, and hypocalcemia [7,8]. Especially, maintenance of a constant intravascular volume is the most important factor to avoid hypovolemic shock [7].…”

“…Although younger age was not a risk factor for adverse events in the TPE procedure, it is a complex process having various technical difficulties including problems related to vascular access, hemodynamic instability, infections, acute volume overload, and hypocalcemia [7,8]. Especially, maintenance of a constant intravascular volume is the most important factor to avoid hypovolemic shock [7]. Michon et al [9] have reported the higher rate of complications related to TPE procedures in the pediatric patients than that in the adult and observed hypotension, symptomatic hypocalcemia, allergic reactions, catheter-related thrombosis, catheter-related infection, and severe anemia frequently.…”

Therapeutic Apheresis in Hematologic, Autoimmune and Dermatologic Diseases With Immunologic Origin

“…Exchange transfusion is the therapy of choice. Recently, TA has also become possible . The diagnosis can be quickly made through the detection of anti‐D antibodies in the mother and examination of the amniotic fluid for bilirubin and anti‐D antibodies.…”