Fluid overload and outcomes in neonates receiving continuous renal replacement therapy

Area of Science:

• Neonatal intensive care
• Pediatric nephrology
• Critical care medicine

Background:

• Continuous renal replacement therapy (CRRT) is the preferred treatment for high-risk neonates with acute kidney injury (AKI), metabolic disorders, and multi-organ dysfunction.
• Fluid overload (FO) is a common complication in these critically ill neonates.
• Understanding factors influencing outcomes in neonates undergoing CRRT is crucial for improving patient care.

Purpose of the Study:

• To evaluate the impact of fluid overload (FO) on outcomes in neonates undergoing CRRT.
• To identify factors associated with mortality and length of hospital stay in neonates receiving CRRT.

Main Methods:

• Retrospective review of medical records for 34 neonates who received at least 24 hours of CRRT.
• Analysis of data including fluid overload percentage, urine output, serum creatinine levels, and demographic information.
• Statistical analysis using univariate and multivariate Cox regression and linear regression models.

Main Results:

• Neonates with FO ≥30% at CRRT initiation had lower survival rates compared to those with FO <30%.
• Higher FO at CRRT initiation and decreased urine output at CRRT completion were associated with mortality.
• Factors associated with longer hospital stay included higher serum creatinine at CRRT initiation, longer pre-CRRT NICU stay, longer CRRT duration, and lower birth weight.

Conclusions:

• Higher fluid overload and elevated serum creatinine levels at CRRT initiation predict poor outcomes in neonates.
• Early initiation of CRRT, before severe FO or azotemia develops, may enhance outcomes for neonates requiring this therapy.