Haemofiltration in Neonates

Abstract

Acute renal failure is defined as the cessation of renal function with or without changes in urinary output. The incidence of acute renal failure in neonatal intensive care units is highly variable, ranging from 1 to 8% [1]. When conventional therapy fails to control fluid and metabolic balances, renal replacement therapy has to be instituted [2]. Of the available methods intermittent hemodialysis and peritoneal dialysis are not always feasible in critically ill patients for technical as well as clinical reasons [3]. Continuous hemofiltration, either driven in the arterio-venous or veno-venous mode, is an alternative continuous renal replacement therapy (CRRT) to control fluid and metabolic balances in critically ill patients [4, 5]. In 1977 Kramer et al. first described continuous arterio-venous hemofiltration (CAVH) as a method for extracorporeal renal support in oliguric adults with diuretic resistant fluid overload [6]. In 1985 the first reports on CAVH in neonates were published by Lieberman et al. and Ronco et al. [7, 8]. In 1989 we reported that CAVH is feasible in critically ill preterm infants to control fluid overload and metabolic derangement [9]. A variety of techniques, such as suction support, predilution, or intermittent or continuous hemodialysis, and pump driven or veno-venous hemofiltration have been described to increase the efficiency of CAVH [10–14].