Abstract

Objective To explore the efficacy and safety of bedside continuous blood purification (CBP) in the treatment of neonatal multiple organ failure (MOF). Methods Totally 6 newborn infants of MOF were hospitalized in department of neonatology in our hospital from June 2011 to June 2013. These 6 cases of clinical data were retrospectively analyzed, 6 neonates were treated with CBP combined with conventional treatment. The model for CBP was continuous veno-venous hemodialysis filtration (CVVHDF), blood flow velocity was 3 to 5 ml/(kg·min), replacement fluid dose was 20 to 30 ml/(kg·h), dialysis fluid dose was 15 to 25 ml/(min·m2). The clinical outcome measures included, blood pressure, blood pH, K+, Na+, blood urea nitrogen, creatinine, urine volume, PaO2/FiO2 and epinephrine intravenous dose, respectively before CBP treatment, 6 h, 12 h, 24 h, 48 h after CBP treatment and the end of CBP treatment. The efficacy of CBP treatment was evaluated in neonatal MOF. Results Gestational age of 6 neonates with MOF was 33 to 41 weeks, 2 to 19 days old, 2.25 to 3.36 kg birth weight. Primary disease was 4 cases of neonatal septicemia (1 case with congenital hereditary metabolic disease), 2 cases of severe neonatal asphyxia. All 6 cases of venous catheter were smoothly done. CBP treatment persisted for 49 to 106 hours. Compared with before CVVHDF treatment, blood K+, blood urea nitrogen, creatinine significantly decreased at 12 h after CVVHDF treatment[(5.32±1.84) mmol/L vs. (9.81±3.61) mmol/L, (9.0±3.4) mmol/L vs. (12.8±6.1) mmol/L, (99±16) μmol/L vs. (176±25) μmol/L, P<0.05], and reached the normal range at 24 h after treatment, urine volume significantly increased at 24 h after treatment (P<0.05). PaO2/FiO2 reached 200 mmHg (1 mmHg=0.133 kPa) at 6 h after treatment and more than 300 mmHg at 24 h after treatment (P<0.05). Fifty percent of epinephrine intravenous dose were down-regulation at 12 h after treatment and stopped using epinephrine at 48 h after treatment. CBP treatment of 6 cases showed effective. Conclusion Application of bedside CBP treatment in neonatal MOF is safe, can effectively help neonates with MOF to skip over renal failure stage. Key words: Continuous blood purification; Multiple organ failure; Critically ill; Neonates

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