Peritoneal Dialysis Prescription for Neonates

Abstract

Despite the major advances in the management of renal failure, the mortality and morbidity rates remain higher in neonates than in older children. But, in most of the cases, effective peritoneal dialysis is possible, giving these neonates a chance of life. In infants and neonates, peritoneal permeability seems to be in a hyperpermeable state, perhaps only related to the volume of the instilled dialysate. Practical peritoneal prescriptions in neonates have to be balanced between either short dwell times optimizing ultrafiltration or long dwell times optimizing the diffusive process and blood purification. The recommendations for peritoneal dialysis in neonates usually admitted are short dwell times, one hour or less, adapted to ultrafiltration need, and small instilled dialysate volumes, 10-20 mL/kg initially, to avoid raised intra-abdominal pressure. Age-related particular risks are hyponatremia and hypophosphatemia.