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AEIOU strategy for continuous renal replacement therapy in infants <10 kg: a practical and educational framework
Mayerly Prada Rico1, Jaime Fernández-Sarmiento2,3, Maria Jose Santiago4
1Department of Pediatrics and Pediatric Nephrology, Universidad del Bosque, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.
Insights
Continuous renal replacement therapy (CRRT) is challenging in infants under 10kg. The AEIOU strategy offers a structured framework to improve the safety and effectiveness of CRRT in this vulnerable pediatric population.
Area of Science:
- Pediatric Nephrology
- Critical Care Medicine
- Neonatology
Background:
- Continuous renal replacement therapy (CRRT) is vital for critically ill children with acute kidney injury (AKI) and fluid overload.
- CRRT in neonates and infants (<10kg) presents unique challenges including limited blood volume, hemodynamic instability, and lack of specialized devices.
- While newer technologies improve feasibility, suboptimal survival outcomes and lack of standardized guidelines persist in this population.
Purpose of the Study:
- To introduce the AEIOU strategy, a novel educational and practical framework designed to simplify and organize essential components for safe and effective CRRT in infants under 10kg.
- To provide a structured mnemonic to aid clinical teams in implementing and managing CRRT in small infants.
- To enhance quality of care, facilitate training, and establish a foundation for future collaborative research in pediatric CRRT.
Main Methods:
- Development of the AEIOU mnemonic: A (Alerts), E (Execution Team), I (Inputs), O (Orders), U (Unified Record).
- Integration of existing literature and clinical experience into a practical framework.
- Focus on key CRRT components: indications, risks, team, equipment, prescription, and documentation.
Main Results:
- The AEIOU strategy provides a structured, reproducible mnemonic for CRRT implementation in infants.
- It addresses critical aspects from initial assessment to outcome monitoring.
- The framework is designed for adaptability to other extracorporeal therapies in pediatrics.
Conclusions:
- The AEIOU strategy offers a simple, comprehensive guide to improve CRRT implementation, education, and outcome monitoring in neonates and small infants.
- Standardized documentation and a structured approach are crucial for improving care in this high-risk group.
- This framework has the potential to enhance CRRT delivery and research in pediatric critical care.
Abstract:
Continuous renal replacement therapy (CRRT) has become a cornerstone in the management of critically ill children with severe acute kidney injury (AKI) and fluid overload. However, its use in neonates and infants weighing less than 10 kg remains particularly challenging due to limited circulating volumes, higher risks of hemodynamic instability, and the scarcity of devices specifically designed for this population. In recent years, new platforms have been introduced, enabling safer extracorporeal support for the smallest patients. Although early experiences suggest that these technologies are feasible and safe, survival outcomes in this fragile group remain suboptimal, and standardized guidelines are still lacking. To address this gap, we propose the AEIOU strategy, an educational and practical framework aimed at organizing and simplifying the essential components required for safe and effective CRRT in infants under 10 kg. AEIOU summarizes: A (Alerts: indications, risks, and contraindications), E (Execution Team), I (Inputs: catheters, machines, filters, and solutions), O (Orders: prescription components such as priming, anticoagulation, blood and effluent flow rates), and U (Unified record: standardized documentation of therapy variables and outcomes) . By integrating existing literature with a reproducible mnemonic, AEIOU provides a structured tool for training clinical teams, ensuring quality of care, and laying the foundation for collaborative research. Beyond CRRT, this framework may be adaptable to other extracorporeal therapies in pediatrics. The AEIOU strategy offers a simple yet comprehensive guide to improve implementation, education, and outcome monitoring of CRRT in neonates and small infants.
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