Treatment of critical neonatal edema with hemo-ultrafiltration

Three neonates with extreme edema associated with cardiovascular and renal insufficiency were treated with hemo-ultrafiltration for removal of critical edema fluid. In each patient peritoneal dialysis had not been effective in expedient fluid removal. Ultrafiltration was accomplished by occlusion of the proximal dialysate portal of a Travenol EX12-11, 0.8 m2 dialyzer and the application of vacuum suction to the distal portal. Blood flow ranged from 10-25 ml/min. The rate of ultrafiltration averaged 0.57 ml/kg/min resulting in losses of 4-16% of body weight. Episodes of hypotension were associated with too rapid ultrafiltration rate and not total volume removed. All patients tolerated the procedure. Two of the three patients demonstrated improvement in blood pressure, oxygenation and urine flow following the ultrafiltration. Ultrafiltration in the newborn may be a useful therapeutic procedure when conventional treatment fails.