Novel extracorporeal therapies in children

In recent years, extracorporeal therapies have expanded beyond their traditional role in acute kidney injury (AKI), providing new possibilities for extracorporeal blood purification, immunomodulation, and organ support in critically ill children. Novel systems such as CytoSorb® and oXiris® enable extracorporeal removal of inflammatory mediators and cytokines, whereas Toraymyxin® and Seraph® target endotoxins and pathogen-associated molecules. The Selective Cytopheretic Device for Pediatrics (SCD-PED) provides immunomodulatory therapy through leukocyte modulation. These technologies are increasingly used in septic shock, cytokine storm syndromes, liver failure, intoxications, and rhabdomyolysis. Additionally, pediatric-oriented platforms such as the Newcastle Infant Dialysis Ultrafiltration System (NIDUS) address technical limitations of CKRT in neonates and low-body-weight children by minimizing extracorporeal circuit volume, whereas extracorporeal carbon dioxide removal (ECCO₂R) expands the role of extracorporeal circuits by providing respiratory support in selected cases of severe hypercapnic respiratory failure. However, pediatric evidence remains limited and is largely derived from case reports, small observational studies, and registry data. Our review summarizes mechanisms of action, current evidence, technical considerations, and limitations of emerging extracorporeal therapies, with emphasis on pediatric applicability and safety.