Neonatal Peritoneal Dialysis

Abstract

After completing this article, readers should be able to: 1. List the indications for peritoneal dialysis (PD) in neonates. 2. Delineate neonates who are poor candidates for PD. 3. Review the parameters of the PD prescription. 4. Review special nutrition considerations for neonates who are undergoing PD. 5. Review potential complications of PD in neonates. Peritoneal dialysis (PD) is generally considered the optimal dialysis modality for neonates. PD allows for the slow removal of fluid and solutes while avoiding hemodynamic instability. It is technically simple and, when necessary, can be performed continuously in the neonate hospitalized in the neonatal intensive care unit. In this review, we discuss the salient features of neonatal PD, including the rationale and indications for PD, its advantages and disadvantages, the PD prescription, nutritional considerations for the neonate undergoing PD, and the management of peritonitis. ### Rationale and Indications for Dialysis in Neonates Acute renal failure is common, occurring in as many as 23% of neonates hospitalized in neonatal intensive care units. There are excellent reviews in the literature that discuss the causes, pathophysiology, and medical management of acute renal failure in the neonate (see Acute Renal Failure Management in the Neonate in this issue of NeoReviews ). A partial list of the causes of acute renal failure in neonates is provided in Table 1. | Prerenal | || | | | Intrinsic | | | | Postrenal | | | Table 1. Causes of Acute Renal Failure The decision to initiate dialysis typically is necessitated by recalcitrant electrolyte abnormalities, worsening uremia, fluid overload, persistent acid-base abnormalities, …