Article Text

AN OVERVIEW OF PERITONEAL DIALYSIS MANAGEMENT IN NEWBORNS DURING A PERIOD OF 10 YEARS
  1. L Sanchez1,
  2. M Cabrera1,
  3. A M Sanchez-Torres1,
  4. D Elorza1,
  5. J Perez1,
  6. J Quero1
  1. 1Neonatal Department, La Paz Hospital, Madrid, Spain

Abstract

Introduction The incidence of acute renal failure (ARF) in neonates ranges from 8 to 24%. Peritoneal dialysis (PD) is a replacement therapy used in the neonatal intensive care unit (NICU) in some cases of ARF.

Objectives To assess indications, methodology and most important complications of PD in newborns.

Materials and Methods Review of medical charts of 39 dialysed newborns, between 1997 and 2007 admitted to a NICU with cardiac surgery.

Results 85% were neonates with cardiac diseases, 5% with inborn errors of metabolism, 10% with other aetiologies. Gestational age and weight ranged from 24 to 36.5 weeks and 700 to 2520 g. Dialysis catheter (Arrow 8F) was inserted at the bedside by the neonatology staff, without complications. Initial mean volume hourly amounts were 15 ml/kg of 1.5% glucose dialysate. Increases in volume, mean 19 ml/kg (10–38 ml/kg) and glucose concentration, mean 3.1% were used to get the objectives. Higher ultrafiltrate volume was 6 ml/kg per hour. Indications for PD in congenital heart diseases were: 67% severe oliguria, 16% anuria, 13% hypervolaemia and 6% others. PD was stated at 14 h after surgery bypass and mean duration was 4 days (0.5–23 days). Complications appeared in 20/34 and were: 50% obstruction, 23% fluid loss, 15% hyperglycaemia, 8% peritonitis and 4% others. Catheter replacement was needed in 15 patients.

Conclusions PD for ARF in newborns is an easy bedside technique, short-term extrarrenal replacement therapy, with few complications. Special usefulness is seen in cardiac patients after bypass surgery.

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