Neonatal extracorporeal renal replacement therapy—a routine renal support modality?

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• 作者：Leyat Tal ; Joseph R. Angelo ; Ayse Akcan-Arikan
• 关键词：Extracorporeal continuous renal replacement therapy ; Acute kidney injury ; Neonates ; nRIFLE ; Continuous venovenous hemodiafiltration
• 刊名：Pediatric Nephrology
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：31
• 期：11
• 页码：2013-2015
• 全文大小：227 KB
• 刊物类别：Medicine
• 刊物主题：Medicine & Public Health
  Pediatrics
  
• 出版者：Springer Berlin / Heidelberg
• ISSN：1432-198X
• 卷排序：31

文摘

Peritoneal dialysis (PD) is generally considered the preferred extracorporeal therapy for neonates with acute kidney injury (AKI). However, there are situations when PD is not suitable, such as in patients with previous abdominal surgery, hyperammonemia and significant ascites or anasarca. Additionally, with a need to start PD soon after catheter placement, there is increased risk of PD catheter leak and infection. Extracorporeal continuous renal replacement therapy (CRRT) is challenging in severely ill neonates as it requires obtaining adequately sized central venous access to accommodate adequate blood flow rates and also adaptation of a CRRT machine meant for older children and adults. In addition, ultrafiltration often cannot be set in sufficiently small increments to be suitable for neonates. Although CRRT practices can be modified to fit the needs of infants and neonates, there is a need for a device designed specifically for this population. Until that becomes available, providing the highest level of care for neonates with AKI is dependent on the shared experiences of members of the pediatric nephrology community.