Early Continuous Renal Replacement Therapy Improves Nutrition Delivery in Neonates During Extracorporeal Life Support

Abstract

Optimizing nutrition in neonatal patients as soon as possible after extracorporeal life support (ECLS) initiation is imperative as malnutrition can worsen both short- and long-term outcomes. Fluid restriction, used to manage the fluid overload that commonly complicates neonatal ECLS, severely impairs nutrition delivery. Continuous renal replacement therapy (CRRT) can be used to help manage fluid overload. We hypothesize that early CRRT utilization ameliorates the need for fluid restriction and allows providers to prescribe higher parenteral nutrition (PN) volumes leading to better nutrition delivery. The design of the study was a retrospective chart review, and the setting was a single, level III neonatal intensive care unit. Neonatal patients (n=42) treated with ECLS between January 1, 2008, and December 31,2013. Comparisons were made between 2 groups: neonates who received ECLS without early CRRT initiation (group 1; n=23) and with early CRRT initiation (group 2; n=19). The main outcome measures were goal total fluid intake, prescribed PN volume, protein, glucose infusion rate, intralipid, and kilocalories. Infants who received early CRRT were prescribed higher mean total fluid intake goals (group 1: 99mL/kg/day vs. group 2: 119mL/kg/day, P<.001) and higher mean volumes of PN (group 1: 61mL/kg/day vs. group 2: 81mL/kg/day, P<.001) over the first 72hours of ECLS compared with infants who did not receive early CRRT. Early CRRT receivers also were prescribed greater mean amounts of protein during the first 72hours of ECLS (group 1: 2.7g/kg/day vs. group 2: 3g/kg/day, P=0.03). There were no significant changes noted in prescribed glucose infusion rates, intralipid, or total kilocalories. Institution of early CRRT in neonates on ECLS allows for administration of greater volumes of PN with improved protein delivery. This study characterizes one benefit of early CRRT initiation in neonates on ECLS and suggests these patients could experience improved nutritional outcomes.