Early Continuous Renal Replacement Therapy Improves Nutrition Delivery in Neonates During Extracorporeal Life Support

Area of Science:

• Neonatal intensive care
• Pediatric critical care
• Renal replacement therapy

Background:

• Optimizing nutrition is crucial for neonatal patients on extracorporeal life support (ECLS) to improve outcomes.
• Fluid restriction, often necessary for fluid overload in neonatal ECLS, impedes adequate nutrition delivery.
• Continuous renal replacement therapy (CRRT) can manage fluid overload, potentially facilitating better nutrition.

Purpose of the Study:

• To investigate if early CRRT initiation in neonatal ECLS patients reduces the need for fluid restriction.
• To determine if early CRRT allows for increased parenteral nutrition (PN) volumes and improved nutritional delivery.
• To test the hypothesis that early CRRT improves nutritional support in neonates undergoing ECLS.

Main Methods:

• Retrospective chart review of 42 neonatal patients treated with ECLS at a single level III NICU.
• Comparison of two groups: ECLS without early CRRT (n=23) and ECLS with early CRRT initiation (n=19).
• Analysis of key nutritional parameters including fluid intake, PN volume, protein, glucose, intralipid, and kilocalories within the first 72 hours of ECLS.

Main Results:

• Neonates receiving early CRRT had significantly higher prescribed fluid intake goals (119 vs. 99 mL/kg/day) and PN volumes (81 vs. 61 mL/kg/day) within 72 hours.
• Early CRRT group received significantly greater mean protein delivery (3 vs. 2.7 g/kg/day).
• No significant differences were observed in prescribed glucose infusion rates, intralipid, or total kilocalories between groups.

Conclusions:

• Early CRRT initiation in neonatal ECLS patients facilitates administration of higher volumes of parenteral nutrition.
• Improved protein delivery was observed in neonates receiving early CRRT.
• Early CRRT may lead to enhanced nutritional outcomes for neonates on ECLS.