Continuous venovenous hemofiltration in neonates with hyperammonemia. A case series

Area of Science:

• Neonatology
• Pediatric Nephrology
• Metabolic Disorders

Background:

• Neonatal hyperammonemia, often due to inborn errors of metabolism, carries high mortality and neurological sequelae.
• Standard medical management is frequently insufficient to control rapidly rising ammonia levels.
• Continuous Renal Replacement Therapy (CRRT) is an established depurative technique for critically ill patients.

Purpose of the Study:

• To evaluate the efficacy and safety of continuous extracorporeal dialysis in neonates with severe hyperammonemia.
• To describe the institutional experience with CRRT for this rare condition.

Main Methods:

• Retrospective review of 6 neonates with hyperammonemia due to metabolic disorders treated with CRRT over 6 years.
• Data collected included demographics, laboratory values (ammonia, creatinine), PIM-II scores, CRRT modality, and duration.
• CRRT initiated based on clinical response, neurological status, or ammonia levels > 400 µg/dL, using Prisma Flex with M100/HF20 filters.

Main Results:

• Six neonates (4 male, 50% premature) presented with severe neurological involvement and extreme hyperammonemia (median 1,663 µg/dL).
• Median PIM-II score was 53; patients received CRRT for a median of 49.5 hours.
• Mortality was 33%, with one survivor experiencing moderate neurological damage.

Conclusions:

• Continuous extracorporeal dialysis is a viable and effective treatment option for extremely ill neonates with hyperammonemia.
• This therapy can be crucial when conventional management fails to control ammonia levels.
• Further research may optimize CRRT protocols for neonatal hyperammonemia management.