Application of bedside continuous blood purification in the treatment of neonatal multiple organ failure

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