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Kidney Replacement Therapy in Low Birth Weight Preterm Newborns
Scott M Sutherland1, Alexis S Davis2, Diana Powell3
1Department of Pediatrics, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California.
Pediatrics
|August 9, 2022
Summary
Innovative kidney replacement therapy successfully managed preterm, low birth weight newborns with end-stage kidney disease. This approach challenges traditional weight thresholds, offering new hope for critically ill neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Nephrology
- Critical Care
Background:
- Managing newborns with kidney failure is challenging due to technical difficulties and adult-designed therapies.
- Intervention is often withheld from smaller neonates, leading to palliative care despite potential survivability.
Purpose of the Study:
- To present an innovative approach for kidney replacement therapy in preterm, low birth weight neonates with end-stage kidney disease.
- To challenge the existing paradigm of excluding very small infants from life-saving interventions.
Main Methods:
- Successfully managed 7 preterm, low birth weight neonates with end-stage kidney disease.
- Utilized 3F and 4F single lumen catheters and a modified ultrafiltration device for kidney replacement therapy.
- Initiated therapy at a median age of 16 days and weight of 1.85 kg.
Main Results:
- Five of the 7 neonates (71%) survived to hospital discharge.
- Achieved excellent metabolic control and fluid homeostasis within the first week of life.
- Survivors demonstrated physiologic weight gain and linear growth during hospitalization.
Conclusions:
- Preliminary findings are encouraging for managing the smallest patients with kidney failure.
- Suggests reevaluation of survivability thresholds for neonatal kidney replacement therapy.
- Highlights the availability of novel approaches for neonatologists to consider.
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