Morelli Stefano, Ricci Zaccaria, Di Chiara Luca, Stazi Giulia V, Polito Angelo, Vitale Vincenzo, Giorni Chiara, Iacoella Claudia, Picardo Sergio
Department of Pediatric Cardiology and Cardiac Surgery, Bambino Gesù Hospital, Rome, Italy.
Contrib Nephrol. 2007;156:428-33. doi: 10.1159/000102134.
The acute renal failure (ARF) incidence in pediatric cardiac surgery intensive care unit (ICU) ranges from 5 to 20% of patients. In particular, clinical features of neonatal ARF are mostly represented by fluid retention, anasarca and only slight creatinine increase; this is the reason why medical strategies to prevent and manage ARF have limited efficacy and early optimization of renal replacement therapy (RRT) plays a key role in the outcome of cardiopathic patients.
Data on neonates admitted to our ICU were prospectively collected over a 6-month period and analysis of patients with ARF analyzed. Indications for RRT were oligoanuria (urine output less than 0.5 ml/kg/h for more than 4 h) and/or a need for additional ultrafiltration in edematous patients despite aggressive diuretic therapy.
Incidence of ARF and need for RRT were equivalent and occurred in 10% of admitted neonates. Eleven patients of 12 were treated by peritoneal dialysis (PD) as only RRT strategy. PD allowed ultrafiltration to range between 5 and 20 ml/h with a negative balance of up to 200 ml over 24 h. Creatinine clearance achieved by PD ranged from 2 to 10 ml/min/1.73 m2. We reported a 16% mortality in RRT patients.
PD is a safe and adequate strategy to support ARF in neonates with congenital heart disease. Fluid balance control is easily optimized by this therapy whereas solute control reaches acceptable levels.
小儿心脏外科重症监护病房（ICU）中急性肾衰竭（ARF）的发生率为患者总数的5%至20%。特别是，新生儿ARF的临床特征主要表现为液体潴留、全身水肿，且肌酐仅有轻微升高；这就是预防和管理ARF的医疗策略疗效有限的原因，而早期优化肾脏替代治疗（RRT）对心脏病患者的预后起着关键作用。
前瞻性收集我院ICU 6个月内收治的新生儿数据，并对ARF患者进行分析。RRT的指征为少尿（尿量<0.5 ml/kg/h超过4小时）和/或尽管积极利尿治疗但水肿患者仍需要额外超滤。
ARF的发生率和RRT的需求相当，在10%的入院新生儿中出现。12例患者中有11例仅采用腹膜透析（PD）作为RRT策略进行治疗。PD的超滤量在5至20 ml/h之间，24小时内负平衡可达200 ml。PD实现的肌酐清除率为2至10 ml/min/1.73 m²。我们报告RRT患者的死亡率为16%。
PD是支持先天性心脏病新生儿ARF的一种安全且合适的策略。通过这种治疗可以轻松优化液体平衡控制，而溶质控制也能达到可接受的水平。
