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PP-84. Acute peritoneal dialysis in the newborn period: A 5.5-year experience at a tertiary neonatal intensive care unit in Turkey

PP-84. Acute peritoneal dialysis in the newborn period: A 5.5-year experience at a tertiary neonatal intensive care unit in Turkey
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  Acute Peritoneal Dialysis in the Newborn Period: A 5.5-Year Experience at a TertiaryNeonatal Intensie !are "nit in Tur#ey Divisions of 1  Neonatology and 2 Pediatric Nephrology, Department of Pediatrics, Dr. SamiUlus Maternity and Children ospital, !n"ara, #ur"ey Introduction: !cute peritoneal dialysis $!PD% provides a non&vascular form of renal replacement therapyfor children at all ages including ne'(orns 'ith acute renal failure $!)*% and certainmeta(olic conditions. Peritoneal dialysis is generally considered the optimal dialysis modalityfor ne'(orns.   !cute renal failure, severe fluid overload and some in(orn   errors of meta(olismare some of the indications for acute   dialysis in ne'(orn infants.   Scant information isavaila(le regarding the prognosis of ne'(orn infants 'ho under'ent !PD. #he aim of this study is to discuss the underlying causes, clinical features, and outcome of ne'(orn patients 'ho under'ent !PD. $aterial and $ethods: #his study included + ne'(orn patients 'ho under'ent !PD (et'een -anuary 2 and-une 21 in the N/CU of Dr. Sami Ulus Maternity and Children ospital. #he demographiccharacteristics and clinical data of the patients 'ere recorded from their medical files.Peritoneal dialysis catheters 'ere placed under sterile conditions. #he catheter type used 'aseither a neonatal straight or pigtail single cuff catheter. #he catheters 'ere threaded throughthe opening in the peritoneum and directed into the pelvis. #he standard dialysate solution'as Dianeal PD, 'ith de0trose concentrations of 1.3, 2.2+ and .3. #o avoid peritoneallea"age, dialysis 'as (egun 'ith little e0change volumes $2 cc4"g%. 5hen re6uired, volume'as increased to 2&7 cc4"g as patients8 respiratory status permitted it. 9ffectiveness of !PD'as measured 'ith the improvement of hyper"alemia, uremia, hyperammonemia, acidosis or fluid overload in the face of oliguria. %esults: During the last .&years, among a total of +: patients admitted to our N/CU, + $13% 'ereunder'ent to !PD procedure. ;ut of + ne'(orn patients, 7< $+3% 'ere full&term and 21$3% 'ere preterm. 5hile 71 of them $:.3% 'ere male, 2< $71.73% 'ere female. !mongthe premature infants, the mean gestational age 'as .+=.:7 'ee"s $27& 'ee"s%, andmean (irth 'eight 'as 1<= g $:7&2: g%. /n general, mean age at (eginning to dialysis'as :.2=1. days $1& days%. #he ma>ority of patients referred for !PD had acute tu(ular necrosis $n?7+, +.13% and meta(olic disorders $n?1, 22.<3%. Main underlying causes of    peritoneal dialysis are given in #a(le 1. *ifteen out of 7+ patients 'ith acute tu(ular necrosis$1.<3% had a cardiovascular procedure. Mean age on commencing !PD 'as +.:=:.+ days$range 1 to  days%. #he primary causes of !)* on these patients 'ere perinatal asphy0ia$21.23%, prematurity $1<.3%, congenital meta(olic disorders $17.:3%, comple0 congenitalheart defects $17.+3% and sepsis $.<3%. #he most common indication for !PD 'as oligo&anuric !)* $n?, +:.3%. 9ight patients of the congenital meta(olic disorders $3% alsohad oligo&anuric state. Dialysis related complications 'ere o(served on 72 patients $3%,'hich 'ere hyperglycemia $3%, lea"age at catheter entrance $1.3%, and peritonitis$1.3%. #he mean duration of dialysis 'as 7.=.<+ days $range 1 to 21 days%. Peritonealdialysis 'as evaluated as effective in all these patients.*ifty&t'o patients $+7.3% died 'ithin 1 to 1 days during peritoneal dialysis. Multi&systemorgan failure $n?27% and meta(olic distur(ance $n?17% 'ere the main reasons for mortality.Causes of the mortality are given in #a(le 2. 5e o(served that the prolonged peritonealdialysis duration $@27 hours% 'as associated 'ith increased ris" of mortality $pA.1%. Discussion: More recently, peritoneal dialysis has (een successfully adapted for ne'(orns that have renalfailure. /n addition, as seen in our study, !PD can (e effective in treating certain neonatalmeta(olic distur(ances, including urea cycle defects 'ith hyperammonemia and congenitallactic acidosis. Peritoneal dialysis is preferred over hemodialysis in the ne'(orn infants dueto the technical difficulties 'hich re6uire e0perience 'ith vascular access in small children.Consistently, this study also sho'ed the effectiveness of !PD in ne'(orns. 9ven though !PD is an invasive procedure, some related complications might occur. /n our study, only a fe' dialyses related complications 'ere o(served. #here is limited data regarding the mortality of ne'(orn infants 'ho under'ent !PD. !sdiscussed in this study, these patients have high mortality rate (ecause of serious nature of theunderlying causes. /n a study conducted (y Bendirli et al. including 1 pediatric patients$mean age .<=. years% 'ho under'ent !PD, the mortality rate 'as found as .+3.Mortality rate increased up to <3 'hen !)* and multiple organ dysfunction syndromeoccurred together. /n another study conducted (y Matthe's and et al. in the patients aged first days of life 'ho under'ent !PD, mortality rate 'as found as 1.3. !onclusion: Peritoneal dialysis is not infre6uently re6uired in a neonatal intensive care setting. !lthough!PD is a safe and effective therapy, these patients had high mortality rate due to the serious  nature of the primary causes. 9arly recognition of the need for !PD and early institution of  peritoneal dialysis can contri(ute to reduction of the mortality in these the patients.  Table &.  Main underlying causes of peritoneal dialysis in N/CU  Dia'nosisPatientnu(ber )n*%ate )+* !cute tu(ular necrosis7++.Meta(olic disorder122.<)enal dysplasia22.<;(structive uropathy22.<ilateral renal vein throm(osis22.<ilateral renal artery throm(osis11.7 , NI!":  Neonatal intensive care unit Table . Causes of the mortality in the patients under'ent !PD E   %eason or (ortalityPatientnu(ber )n*%ate)+* Multi&system organ failure277.1Meta(olic disorder172.<Cardiac failure:1.7Sepsis11. / APD:  !cute peritoneal dialysis  %eerences 1.Chien -C, 'ang #, 5eng FC, Meng GC, Gee PC. Peritoneal dialysis in infants andchildren after open heart surgery. Pediatr Neonatol 2<H ?2+&<.2.Iu -9, Par" MS, Pai BS. !cute peritoneal dialysis in very lo' (irth 'eight neonatesusing a vascular catheter. Pediatr Nephrol 21H 2?+&+1. .Jole> -, BitKmueller 9, ermon M, oigner , urda J, #ritten'ein J. Go'&volume peritoneal dialysis in 11 neonatal and paediatric critical care patients. 9ur - Pediatr 22H 11?:&<. 7.latK S, Paes , Steele . Peritoneal dialysis in the neonate. Neonatal Net' 1<<H:?71&7..lo'ey DG, Mc*arland B, !lon U, McJra'&ouchens M, ellerstein S, 5arady !.Peritoneal dialysis in the neonatal period? outcome data. - Perinatol 1<<H 1?<&7..!ndreoli SP. !cute renal failure in the ne'(orn. Semin Perinatol 27H 2:?112&2. +.Matthe's D9, 5est B5, )escorla *-, Lane D5, Jrosfeld -G, 5appner )S, ergstein-, !ndreoli S. Peritoneal dialysis in the first  days of life. - Pediatr Surg 1<<H2?11&.:.!gras P/, #arcan !, as"in 9, CengiK N, Jra"an , Saatci U. !cute renal failure inthe neonatal period. )en *ail 27H 2? &<.  <.Passada"is PS, ;reopoulos DJ. Peritoneal dialysis in patients 'ith acute renal failure.!dv Perit Dial 2+H 2?+&1.1.Pedersen B), >ortdal L9, Christensen S, Pedersen -, >ortholm B, Garsen S,Povlsen -L. Clinical outcome in children 'ith acute renal failure treated 'ith peritoneal dialysis after surgery for congenital heart disease. Bidney /nt Suppl 2:1:?:1&.
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