[Hemofiltration in acute neonatal metabolic crisis].

Continuous arteriovenous hemofiltration (CAVH) and venovenous hemofiltration (CVVH) were successfully used in the treatment of two neonates, one with maple syrup urine disease and the other with ornithine transcarbamylase deficiency. The plasma concentrations of branched-chain amino acids as well as of ammonium decreased to non-toxic values within a few hours and the clinical improvement in the encephalopathy was striking. Our results and a review of the literature show that hemofiltration is more effective than peritoneal dialysis in removing toxic metabolites. The best clearance rates are achieved by intermittent hemodialysis, but continuous hemofiltration is a simple, safe and effective alternative and is sometimes tolerated better by critically ill infants.