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Feasibility of peritoneal dialysis in extremely low birth weight infants
Francesco Macchini1, Agnese De Carli, Sara Testa
1Department of Pediatric Surgery, Fondazione IRCCS Cá Granda, Ospedale Maggiore Policlinico, Milan, Italy.
Insights
Peritoneal dialysis (PD) is a viable treatment for acute renal failure in extremely low birth weight (ELBW) infants. Despite technical challenges due to small size, PD proved effective in three ELBW infants, offering a crucial rescue therapy option.
Area of Science:
- Neonatology
- Pediatric Nephrology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) affects 8-24% of extremely low birth weight (ELBW) infants.
- Peritoneal dialysis (PD) is infrequently used in ELBW infants due to perceived technical difficulties.
Purpose of the Study:
- To report the feasibility and effectiveness of PD in ELBW infants with AKI.
- To describe solutions for challenges associated with PD in this patient population.
Main Methods:
- PD was performed in three ELBW infants diagnosed with acute renal failure.
- Catheter types used included neonatal Tenckhoff and Broviac vascular catheters.
- Technical challenges related to infant size and catheter fit were addressed.
Main Results:
- Successful PD was achieved in all three ELBW infants.
- PD was effective in treating acute renal failure.
- Catheter leakage occurred with Tenckhoff catheters but did not compromise PD efficacy.
Conclusions:
- Peritoneal dialysis is a feasible and effective treatment for AKI in ELBW infants.
- PD can be considered a critical rescue therapy for preterm ELBW infants with renal failure.
- Adaptations in catheter use and technique can overcome size-related challenges.
Abstract:
Acute renal injury is common in extremely low birth weight (ELBW) infants with a frequency ranging from 8% to 24%. Peritoneal dialysis (PD) has been used only occasionally in ELBW. We report our experience and share the solutions used to tackle the difficulties rising from the small size of this type of patients. PD was successfully performed in three ELBW infants with acute renal failure. A neonatal, single-cuff, straight Tenckhoff catheter was placed in 2 patients, while a Broviac single cuff vascular catheter was used in another. PD was feasible and effective in all children. Leakage was observed with Tenckhoff catheters, but this did not impair the PD efficacy. The technical difficulties were related to the size and shape of the peritoneal catheters, not easily fitting with the very thin abdominal wall of the preterm infants. We conclude that PD is feasible and effective, can be considered as the rescue therapy in preterm ELBW infants with acute renal failure.
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Acute kidney injury develops suddenly and can be caused by pre-renal causes (e.g., hypovolemia, shock), intrinsic renal causes (e.g., acute tubular necrosis), or post-renal causes (e.g., urinary obstruction). In contrast, chronic renal failure progresses gradually over time and is often...