Continuous Renal Replacement Therapy in the Neonatal Intensive Care Unit: A Single-Center Study.

Oh,  Moon Yeon; Lee,  Byong Sop; Oh,  Seong Hee; Jang,  Hee Jin; Do,  Hyun Jeong; Kim,  Ellen Ai Rhan; Kim,  Ki Soo; Lee,  Joo Hoon; Park,  Young Seo; Lee,  Beom Hee; Yoo,  Han Wook

doi:2014.21.4.244

Neonatal Med > Volume 21(4); 2014 > Article

Original Article

Neonatal Medicine 2014;21(4):244-250.
DOI: https://doi.org/10.5385/nm.2014.21.4.244 Published online November 30, 2015.

Continuous Renal Replacement Therapy in the Neonatal Intensive Care Unit: A Single-Center Study.

Moon Yeon Oh, Byong Sop Lee, Seong Hee Oh, Hee Jin Jang, Hyun Jeong Do, Ellen Ai Rhan Kim, Ki Soo Kim, Joo Hoon Lee, Young Seo Park, Beom Hee Lee, Han Wook Yoo

Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea. mdleebs@amc.seoul.kr

Abstract

PURPOSE
Continuous renal replacement therapy (CRRT) has become an essential modality for the care of critically ill pediatric patients who require renal support. However, experience with CRRT in the neonatal population is not common in Korea. In this study, we aimed to investigate the clinical features, outcomes, and complications of CRRT in neonates in a single neonatal intensive care unit (NICU).
METHODS
We reviewed the medical records of 17 neonates who underwent CRRT at a NICU of a tertiary hospital. The data included demographic characteristics, diagnosis, complications, and laboratory and CRRT parameters.
RESULTS
The median age at initiation of CRRT was 6 days after birth. All patients were treated with CRRT in continuous venovenous hemodiafiltration mode, with a median treatment duration of 57 hours. The main indication for CRRT was an inborn error of metabolism (IEM), followed by congenital renal disease and multiorgan failure. In patients with an IEM, the median plasma ammonia level at the CRRT initiation was 1,232 micromol/L, and the mean duration until the ammonia level decreased to half of the peak ammonia level was 7.3+/-2.5 hours. The overall hospital mortality rate was 41.2%. The outcomes of the 10 survivors after discharge included death (n=2), loss to follow-up (n=3), and survival with developmental delay (n=4).
CONCLUSION
Although CRRT was effective in lowering the plasma ammonia level of neonates with IEM, the associated mortality and morbidity were high. Hence, further studies are needed to optimize the CRRT protocol and to establish an effective patient referral system in Korea.

Key Words: Continuous renal replacement therapy; Neonatal intensive care unit; Inborn errors of metabolism; Hyperammonemia