Sohn Young Bae, Paik Kyung Hoon, Cho Hee Yeon, Kim Su Jin, Park Sung Won, Kim Eun Sun, Chang Yun Sil, Park Won-Soon, Choi Yoon-Ho, Jin Dong-Kyu
Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Korean J Pediatr. 2012 Aug;55(8):286-92. doi: 10.3345/kjp.2012.55.8.286. Epub 2012 Aug 23.
Continuous renal replacement therapy (CRRT) is becoming the treatment of choice for supporting critically ill pediatric patients. However, a few studies present have reported CRRT use and outcome in neonates weighing less than 3 kg. The aim of this study is to describe the clinical application, outcome, and complications of CRRT in small neonates.
A retrospective review was performed in 8 neonatal patients who underwent at least 24 hours of pumped venovenous CRRT at the Samsung Medical Center in Seoul, Korea, between March 2007 and July 2010. Data, including demographic characteristics, diagnosis, vital signs, medications, laboratory, and CRRT parameters were recorded.
The data of 8 patients were analyzed. At the initiation of CRRT, the median age was 5 days (corrected age, 38(+2) weeks to 23 days), and the median body weight was 2.73 kg (range, 2.60 to 2.98 kg). Sixty-two patient-days of therapy were reviewed; the median time for CRRT in each patient was 7.8 days (range, 1 to 37 days). Adverse events included electrolyte disturbances, catheter-related complications, and CRRT-related hypotension. The mean circuit functional survival was 13.9±8.6 hours. Overall, 4 patients (50%) survived; the other 4 patients, who developed multiorgan dysfunction syndrome, died.
The complications of CRRT in newborns are relatively high. However, the results of this study suggest that venovenous CRRT is feasible and effective in neonates weighing less than 3 kg under elaborate supportive care. Furthermore, for using potential benefit of CRRT in neonates, efforts are required for prolonging filter survival.
连续性肾脏替代疗法（CRRT）正成为支持危重症儿科患者的首选治疗方法。然而，目前仅有少数研究报道了体重不足3kg的新生儿使用CRRT的情况及预后。本研究旨在描述CRRT在小体重新生儿中的临床应用、预后及并发症。
对2007年3月至2010年7月在韩国首尔三星医疗中心接受至少24小时泵驱动静脉-静脉CRRT的8例新生儿患者进行回顾性研究。记录包括人口统计学特征、诊断、生命体征、用药情况、实验室检查及CRRT参数等数据。
分析了8例患者的数据。CRRT开始时，中位年龄为5天（矫正年龄，38（+2）周至23天），中位体重为2.73kg（范围2.60至2.98kg）。共回顾了62个患者治疗日；每位患者CRRT的中位时间为7.8天（范围1至37天）。不良事件包括电解质紊乱、导管相关并发症及CRRT相关低血压。平均体外循环功能存活时间为13.9±8.6小时。总体而言，4例患者（50%）存活；另外4例发生多器官功能障碍综合征的患者死亡。
新生儿CRRT的并发症相对较高。然而，本研究结果表明，在精心的支持治疗下，静脉-静脉CRRT在体重不足3kg的新生儿中是可行且有效的。此外，为了发挥CRRT在新生儿中的潜在益处，需要努力延长滤器存活时间。
