Use of a soft catheter for acute peritoneal dialysis in infants and children.

Acute peritoneal dialysis in 49 infants and children is described comparing the use of the conventional hard Trocath catheter and the soft catheter. The mean age of the patients was 3.6 years (range 1 day--17 years). Sixteen were treated using the hard Trocath catheter and 33 were treated using a soft catheter. Overall mortality for the total patient population was 43%. Twenty-three neonates were included in the series with an overall mortality of 61%. Significantly less mortality was observed in the 26 patients older than two months of age (31%). Major complications of the dialysis procedure included viscus perforation in three neonatal patients and subcutaneous extravasation of dialysate in two older patients. These major complications occurred only with the use of the Trocath. Two episodes of peritonitis occurred in two adolescent patients and were associated with an interruption of the sterile system. Peritonitis was not specifically related to the type of catheter used. We conclude that major complications associated with the use of the hard catheter for peritoneal dialysis in neonates precludes its continued use in this population. The alternative use of a soft catheter is recommended in neonates. Elective use of a soft catheter for acute peritoneal dialysis in older patients would also seem to be indicated.