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A machine for haemodialysing very small infants
Nicholas L Everdell1, Malcolm G Coulthard, Jean Crosier
1Department of Medical Physics and Bioengineering, Malet Place, Engineering Building, University College London, London, WC1E 6BT, UK. everdell@medphys.ucl.ac.uk
Pediatric Nephrology (Berlin, Germany)
|March 18, 2005
Summary
This study introduces a computer-controlled hemodialysis machine designed for infants, enabling effective treatment for neonates and small babies with kidney issues. The innovative system simplifies the process, ensuring efficient dialysis for critically ill infants.
Area of Science:
- Pediatrics
- Nephrology
- Biomedical Engineering
Background:
- Hemodialysis in infants under 6 kg presents significant challenges due to small blood volume and low access vessel flow.
- Existing methods like peritoneal dialysis are less efficient, and traditional hemodialysis requires blood-primed circuits, posing risks for neonates.
- Infant hemodialysis is complicated by the need for large extracorporeal circuits relative to blood volume and low blood flow rates.
Purpose of the Study:
- To develop and evaluate a computer-controlled hemodialysis machine for infants, addressing the limitations of existing methods.
- To minimize complications associated with infant hemodialysis, such as the need for blood-primed circuits and inadequate blood flow.
- To provide a safe, effective, and convenient hemodialysis solution for neonates and small infants with renal failure or metabolic disorders.
Main Methods:
- Development of a computer-controlled, pressure-monitored hemodialysis machine with automated blood withdrawal rate adjustment.
- Utilization of a single lumen access, a very small circuit, and a reservoir syringe to manage blood flow.
- Application of the developed system to dialyze four infants weighing 0.8-3.4 kg.
Main Results:
- The hemodialysis circuits did not require priming with blood.
- Effective clearances were achieved for creatinine, urea, potassium, phosphate, and ammonia (mean 0.54-0.98 ml/min).
- Ammonia clearance demonstrated a 9-hour half-life in a 2.4 kg infant, with ultrafiltration up to 45 ml/h easily achieved.
Conclusions:
- The computer-controlled hemodialysis machine offers an immediate, effective, and convenient treatment option for infants.
- This technology successfully overcomes the challenges of hemodialysis in neonates and small babies, enabling prolonged treatment periods.
- The developed system enhances the safety and efficiency of hemodialysis for critically ill infants, minimizing risks associated with traditional methods.