Short Kara, Hanick Janelle, Bickert Perrin, Potts Jessica, Askenazi David
Children's of Alabama, Birmingham, USA.
Pediatric and Infant Center for Acute Nephrology, Children's of Alabama and University of Alabama at Birmingham, Birmingham, USA.
Pediatr Nephrol. 2025 Aug 7. doi: 10.1007/s00467-025-06887-y.
With advanced technology, survival of neonates with congenital kidney failure (CKF) requiring continuous kidney replacement therapy (CKRT) has improved. Nutrition is essential but difficult to attain as CKRT removes proteins and micronutrients, and many patients have multiple co-morbidities. Scant data exist to guide clinicians on appropriate energy requirements for growth.
We performed a retrospective study of neonates with CKF admitted to Children's of Alabama between 2016 and 2022 who required KRT within 10 days. We evaluated risk factors and growth in the 18/24 (75%) infants who survived to 90 days. Our primary and secondary outcomes were length z-score ≥ - 2 vs. < - 2 at 90 days and weight z-score ≥ - 2 vs. < - 2 at 90 days, respectively. Demographics, comorbidities, CKRT Dose Eras (1-body surface area (2000/1.73/m/hr) vs. 2-weight-based era (24 ml/kg/hr)), and Nutrition Era 1 vs. 2 were evaluated.
At 90 days, 7/18 (38.9%) had length z-score ≥ - 2 while 10/18 (55.6%) had a weight z-score ≥ - 2. Factors for weight z-score ≥ - 2 include time to PD transition and CKRT Dose Era 2. Factors for length z-score ≥ - 2 included Era with higher calorie and protein goal targets (both p < 0.01).
Malnutrition in neonates with CKF on CKRT is high. More studies are needed to better understand optimal strategies to ensure adequate growth. Until then, we recommend 24 ml/kg/hr clearance dose and prescribing at least 130 kcal/kg/day and 4 g/kg/day amino acids to target higher actual intake to start for these patients.
随着技术的进步，需要持续肾脏替代治疗（CKRT）的先天性肾衰竭（CKF）新生儿的存活率有所提高。营养至关重要，但由于CKRT会清除蛋白质和微量营养素，且许多患者有多种合并症，因此难以实现。目前几乎没有数据可指导临床医生确定适合生长的能量需求。
我们对2016年至2022年期间入住阿拉巴马州儿童医院且在10天内需要进行肾脏替代治疗（KRT）的CKF新生儿进行了一项回顾性研究。我们评估了18/24（75%）存活至90天的婴儿的风险因素和生长情况。我们的主要和次要结局分别是90天时身长z评分≥ -2与< -2，以及90天时体重z评分≥ -2与< -2。评估了人口统计学、合并症、CKRT剂量时代（1-体表面积（2000/1.73/m/hr）与2-体重计算时代（24 ml/kg/hr））以及营养时代1与2。
90天时，7/18（38.9%）的身长z评分≥ -2，而10/18（55.6%）的体重z评分≥ -2。体重z评分≥ -2的因素包括开始腹膜透析（PD）转换的时间和CKRT剂量时代2。身长z评分≥ -2的因素包括卡路里和蛋白质目标更高的时代（两者p<0.01）。
接受CKRT的CKF新生儿营养不良的发生率很高。需要更多研究来更好地理解确保充足生长的最佳策略。在此之前，我们建议这些患者的清除剂量为24 ml/kg/hr，并规定至少130 kcal/kg/天和4 g/kg/天的氨基酸，以实现更高的实际摄入量。
