Wu Chen-Yu, Lin Yung-Chieh, Chen Chih-Chia
Department of Pediatrics, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Pediatrics, College of Medicine, National Cheng-Kung University, Tainan, Taiwan.
Front Pediatr. 2021 Nov 17;9:769220. doi: 10.3389/fped.2021.769220. eCollection 2021.
Emerging data indicate that acute kidney injury (AKI) may contribute to a worse prognosis in the infant population. Kidney replacement therapy (KRT) can be used to treat patients with AKI; however, this technique is challenging in patients in the neonatal intensive care units (NICUs) due to the low body weights and blood volumes in this population. Peritoneal dialysis (PD) is a potential modality since it is technically less challenging. However, PD has been associated with several disadvantages, including poor fluid status control, catheter-associated leakage, and peritonitis. Unfortunately, these complications can cause the temporary cessation of PD. Continuous kidney replacement therapy (CKRT) may represent a suitable alternative for PD. CKRT may be technically feasible in infants; however, little is known about the application of CKRT in neonates with low body weights. In this report, we discuss three cases of CKRT who were treated in the NICU at a tertiary medical center in southern Taiwan. We selected an adequate catheter diameter and achieved vascular access an internal jugular vein or umbilical vein. The prescription of an appropriate dose of heparin was then used to prolong the circuit life of the CKRT. The maintenance of circuit durability in neonates with low body weight remains problematic. We hope that our experience can assist with the future clinical management of CKRT in neonates with low body weight.
新出现的数据表明，急性肾损伤（AKI）可能会导致婴儿群体的预后更差。肾脏替代疗法（KRT）可用于治疗AKI患者；然而，由于新生儿重症监护病房（NICUs）患者体重低、血容量少，这项技术在该群体中具有挑战性。腹膜透析（PD）是一种潜在的治疗方式，因为其技术难度较低。然而，PD存在一些缺点，包括液体状态控制不佳、导管相关渗漏和腹膜炎。不幸的是，这些并发症可能导致PD暂时停止。连续性肾脏替代疗法（CKRT）可能是PD的合适替代方案。CKRT在婴儿中技术上可能可行；然而，关于CKRT在低体重新生儿中的应用知之甚少。在本报告中，我们讨论了在台湾南部一家三级医疗中心的NICU接受治疗的三例CKRT病例。我们选择了合适的导管直径，并通过颈内静脉或脐静脉实现了血管通路。然后使用适当剂量的肝素处方来延长CKRT的体外循环寿命。在低体重新生儿中维持体外循环的耐久性仍然存在问题。我们希望我们的经验能有助于未来对低体重新生儿进行CKRT的临床管理。
