PMID- 35945293
OWN - NLM
STAT- MEDLINE
DCOM- 20220908
LR  - 20220915
IS  - 1098-4275 (Electronic)
IS  - 0031-4005 (Linking)
VI  - 150
IP  - 3
DP  - 2022 Sep 1
TI  - Kidney Replacement Therapy in Low Birth Weight Preterm Newborns.
LID - e2022056570 [pii]
LID - 10.1542/peds.2022-056570 [doi]
AB  - Managing newborns with kidney failure is a complex undertaking; even under ideal 
      circumstances, dialysis is technically challenging and available therapies are 
      designed for adults. These issues are exacerbated in smaller newborns, and 
      intervention has traditionally not been offered in those below a certain weight 
      threshold. Ethical concerns abound and patients deemed too small for dialysis are 
      typically transitioned to comfort or palliative care. However, many of these 
      neonates are otherwise healthy and would be considered survivable if kidney 
      replacement therapy were available. To challenge the existing paradigm, we 
      present 7 preterm, low birth weight neonates with end-stage kidney disease who 
      were successfully managed using an innovative approach to kidney replacement 
      therapy. These newborns had a median gestational age of 32 weeks (interquartile 
      range [IQR], 32-35) and a median birth weight of 1.58 kg (IQR, 1.41-2.01). Kidney 
      replacement therapy was initiated at a median age of 16 days (IQR, 1.5-40) and a 
      weight of 1.85 kg (IQR, 1.57-2.1). Five of the 7 newborns (71%) survived to 
      hospital discharge. Kidney replacement therapy was provided using 3F and 4F 
      single lumen catheters and a modified ultrafiltration device. Patients 
      experienced excellent metabolic control, and fluid homeostasis was achieved in 
      the first week of life. Furthermore, survivors experienced physiologic weight 
      gain and linear growth throughout their hospitalization. These findings, although 
      preliminary, are encouraging for our smallest patients with kidney failure and 
      suggest that survivability thresholds should be reexamined. At a minimum, 
      neonatologists should be aware that novel approaches exist and may be considered 
      for these challenging patients.
CI  - Copyright (c) 2022 by the American Academy of Pediatrics.
FAU - Sutherland, Scott M
AU  - Sutherland SM
AD  - Department of Pediatrics, Division of Nephrology, Stanford University School of 
      Medicine, Palo Alto, California.
FAU - Davis, Alexis S
AU  - Davis AS
AD  - Department of Pediatrics, Division of Neonatal and Developmental Medicine, 
      Stanford University School of Medicine, Palo Alto, California.
FAU - Powell, Diana
AU  - Powell D
AD  - Neonatal Intensive Care Unit, Lucile Packard Children's Hospital, Palo Alto, 
      California.
FAU - Tanaka, Jennifer
AU  - Tanaka J
AD  - Pediatric Dialysis Unit, Lucile Packard Children's Hospital, Palo Alto, 
      California.
FAU - Woo, Mayna
AU  - Woo M
AD  - Pediatric Dialysis Unit, Lucile Packard Children's Hospital, Palo Alto, 
      California.
FAU - Josephs, Shellie
AU  - Josephs S
AD  - Department of Radiology, Division of Interventional Radiology, Stanford 
      University School of Medicine, Palo Alto, California.
FAU - Wong, Cynthia J
AU  - Wong CJ
AD  - Department of Pediatrics, Division of Nephrology, Stanford University School of 
      Medicine, Palo Alto, California.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Pediatrics
JT  - Pediatrics
JID - 0376422
SB  - IM
MH  - Adult
MH  - Birth Weight
MH  - Gestational Age
MH  - Humans
MH  - Infant
MH  - Infant, Low Birth Weight
MH  - Infant, Newborn
MH  - *Infant, Premature
MH  - *Renal Insufficiency
MH  - Renal Replacement Therapy
EDAT- 2022/08/10 06:00
MHDA- 2022/09/09 06:00
CRDT- 2022/08/09 23:22
PHST- 2022/06/01 00:00 [accepted]
PHST- 2022/08/10 06:00 [pubmed]
PHST- 2022/09/09 06:00 [medline]
PHST- 2022/08/09 23:22 [entrez]
AID - 188738 [pii]
AID - 10.1542/peds.2022-056570 [doi]
PST - ppublish
SO  - Pediatrics. 2022 Sep 1;150(3):e2022056570. doi: 10.1542/peds.2022-056570.