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Continuous renal replacement therapy in extremely low birth weight infants: a series of 5 cases
1Neonatal Intensive Care Unit, Department of Pediatrics, the Third Xiangya Hospital of Central South University, Changsha, Hunan, China.
Insights
Continuous renal replacement therapy (CRRT) is feasible in extremely low birth weight (ELBW) infants in China. However, improving survival rates and long-term outcomes for these vulnerable newborns remains a significant challenge.
Area of Science:
- Neonatal Medicine
- Pediatric Nephrology
- Critical Care
Background:
- Continuous renal replacement therapy (CRRT) is crucial for acute kidney injury (AKI) in critical patients.
- Administering CRRT to extremely low birth weight (ELBW) infants (<1000 g) poses unique challenges.
- This study evaluates the feasibility and safety of CRRT in ELBW infants in China.
Purpose of the Study:
- To assess the feasibility and safety of CRRT in extremely low birth weight (ELBW) infants.
- To summarize initial experiences with CRRT in this specific neonatal population.
- To identify challenges and areas for improvement in CRRT for ELBW infants.
Main Methods:
- CRRT was performed in ELBW infants at a tertiary medical center in China (2021-2023).
- Vascular access involved ultrasound-guided placement of a 5.0Fr double-lumen catheter.
- Extracorporeal circuits were primed with compatible blood for initiation of therapy.
Main Results:
- Five ELBW infants (birth weight as low as 450 g) underwent CRRT.
- CRRT was successfully initiated in all patients, with four completing the planned treatment duration (up to 65 hours).
- Two infants survived to 28 days but later withdrew due to severe neurological sequelae.
Conclusions:
- This is the first study on CRRT in ELBW infants in China.
- CRRT appears feasible in ELBW infants, but survival and long-term prognosis require significant improvement.
- Further research is needed to optimize CRRT protocols and outcomes for this high-risk group.
Background:
Continuous renal replacement therapy (CRRT) plays a pivotal role in delivering renal support to critical patients with acute kidney injury (AKI). However, administering CRRT to extremely low birth weight (ELBW) infants, defined as those with a birth weight under 1000 g, presents distinct challenges. We summarized our experiences of the ELBW infants who were treated with CRRT at a tertiary medical center in China, and evaluated its feasibility and safety in this group of patients.
Methods:
ELBW infants were performed CRRT at the neonatal intensive care unit (NICU), the Third Xiangya Hospital of Central South University, a tertiary medical center in China, between 2021 and 2023.
Results:
A total of 5 ELBW infants with a minimum birth weight of 450 g were involved in this study. At the commencement of CRRT, four patients still weighed less than 1000 g, with the lowest being 700 g. We placed a 5.0Fr double-lumen catheter in the internal jugular vein or femoral vein under ultrasound guidance. The extracorporeal circuit was primed with compatible blood. CRRTs were successfully initiated in all patients. Four patients completed CRRT as planned, and the maximum cumulative CRRT time was 65 h. Only two patients were still alive at 28-day, but eventually dropped out of treatment for severe neurological sequelae.
Conclusions:
This is the first research of ELBW infants' CRRT in China. Our findings indicate that CRRT may be feasible in ELBW infants, but improving the survival rate and long-term prognosis remains a challenge in those newborns undergoing such procedure.
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