Acute peritoneal dialysis in the newborn: A safe and feasible method

Abstract

IntroductionWe aimed to evaluate the patient characteristics of neonates treated with peritoneal dialysis (PD) and review our experience with placement of PD catheters. MethodsRecords of neonates treated with PD between January 2019 and January 2022 were retrospectively analyzed. ResultsSwan neck curl PD catheters with double cuffs were used in 85 neonates as a bedside procedure with one cuff remaining within the abdomen. There were 44 (51.7%) males and 41 (48.3%) females. Their mean gestational age was 33.6 ± 4.9 (22–40) weeks and the mean birth weight was 2315,5 ± 1039 (500–4700) g. The primary diagnoses were asphyxia (n = 22, 25.9%), prematurity (n = 21, 24.7%), inborn errors of metabolism (n = 11, 12.9%), sepsis (n = 7, 8.2%), necrotizing enterocolitis (n = 5, 5.9%), dehydration (n = 5, 5.9%), hydrops fetalis (n = 5, 5.9%), congenital heart diseases (n = 5, 5.9%) and renal anomalies (n = 4, 4.7%). The mean duration of PD was 11.6 ± 13.7 days (range 1 to 75 days). Catheter-related complications occurred in 7 (8.2%) patients. These were drainage problems (n = 4), leakage (n = 1), incisional hernia (n = 1) and wound dehiscence (n = 1). Mortality because of underlying condition occurred in 57 (67.1%) patients. Mean pre-dialysis pH and sodium levels were statistically higher in surviving newborns than in those with a fatal outcome (7.19 vs 7.09 and 144.4 mmol/L vs 134.6 mmol/L, respectively) (p<0.05). ConclusionsPD is a safe, simple and effective therapy in neonates. The mortality rate in those treated with PD is high, especially due to serious underlying diseases. Lack of appropriate devices necessitates revisions in the catheters and techniques used for PD treatment. Type of studyCase series Level of evidenceIV