Abstract P-246: CONTINUOUS RENAL REPLACEMENT THERAPY IN NEONATES WITH HYPERAMMONEMIA

Abstract

Aims & Objectives: Hyperammonemia in neonates can cause neurotoxic symptoms, and continuous renal replacement therapy (CRRT) is useful modality for the critical care of neonates with hyperammonemia caused by inborn errors of metabolism (IEM). The aim of this study is to evaluate the outcomes of CRRTand the prescriptions of CRRT to effectively reduce the plasma levels of ammonia in neonates with hyperammonemia. Methods The medical records of 12 Korean neonates with IEM who underwent CRRT for hyperammonemia from January 2008 to December 2016 were retrospectively analyzed. Results The median age of neonatal intensive care unit admission due to hyperammonemia was 4 days, and 2 patients were preterm babies. Male to female ratio was 2:1. The final diagnosis for hyperammonemia included ornithine transcarbamylase deficiency (n=4), citrullinemia (n=4), carbamoyl phosphate synthetase deficiency (n=2), and propionic academia (n=2). All patients received continuous veno-venous hemodiafiltration. The median blood flow rate at the initiation of CRRT was 9.6 ml/kg/min. The median ultrafiltration rate (UFR) at the initiation of CRRT was 2,448 ml/hr/1.73m2, and increased up to the median levels of 3,456 ml/hr/1.73m2. The median duration of CRRT was 4.5 days. The median plasma ammonia level at CRRT initiation was 1115.8 umol/L. The median value of estimated half time for plasma ammonia level after CRRT was 12.8 hour. Six patients restarted CRRT because of rebound hyperammonemia, and the survival rate was 83.3%. Conclusions This study suggested that CRRT could be a therapeutic option for neonates with IEM, and patients with high plasma ammonia levels need to increase UFR above 4000ml/hr/1.73m2.