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      Challenges of acute peritoneal dialysis in extremely-low-birth-weight infants: a retrospective cohort study

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          Abstract

          Background

          Peritoneal dialysis (PD) has been used occasionally in extremely-low-birth-weight (ELBW) infants with acute kidney injury (AKI). This study aimed to evaluate the clinical characteristics and outcomes of ELBW infants with AKI treated with PD.

          Methods

          In this retrospective cohort study, the medical records of ELBW infants with AKI, who underwent PD from January 2008 to February 2018, were reviewed. A PD catheter (7.5–9.0 Fr) or central venous catheter (4 Fr) was used for the peritoneal access. Treatment with PD solutions (2.5 or 4.25%) was started at 10 mL/kg, which was increased to 20–30 mL/kg for 60–120 min/cycle continuing for 24 h.

          Results

          Twelve ELBW infants (seven male and five female infants) were treated, and their mean (±SD) gestational age and birth weight were 27.2 (±3.3) weeks and 706.5 (±220.5) g, respectively. Two patients had severe perinatal asphyxia (5-min Apgar score ≤ 3). The most important indication for starting PD was AKI due to sepsis. The average (±SD) duration of PD was 9.4 (± 7.7) days. The potassium levels in the ELBW infants with hyperkalemia decreased from 6.8 to 5.0 mg/mL after 9.3 (± 4.4) days. The most common complication of PD was mechanical dysfunction of the catheters, such as dialysate leakage (75%). Two patients were successful weaned off PD. The mortality rate of the infants treated with PD was 91.7%.

          Conclusions

          In this series, the mortality rate of ELBW infants with AKI treated with PD was relatively high because of their incompletely developed organ systems. Therefore, the use of PD should be carefully considered for the treatment of ELBW infants with AKI in terms of decisions regarding resuscitation.

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          Most cited references39

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          Bronchopulmonary dysplasia.

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            Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging.

            A method of clinical staging for infants with necrotizing enterocolitis (NEC) is proposed. On the basis of assigned stage at the time of diagnosis, 48 infants were treated with graded intervention. For Stage I infants, vigorous diagnostic and supportive measures are appropriate. Stage II infants are treated medically, including parenteral and gavage aminoglycoside antibiotic, and Stage III patients require operation. All Stage I patients survived, and 32 of 38 Stage II and III patients (85%) survived the acute episode of NEC. Bacteriologic evaluation of the gastrointestinal microflora in these neonates has revealed a wide range of enteric organisms including anaerobes. Enteric organisms were cultured from the blood of four infants dying of NEC. Sequential cultures of enteric organisms reveal an alteration of flora during gavage antibiotic therapy. These studies support the use of combination antimicrobial therapy in the treatment of infants with NEC.
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              Recognition and reporting of AKI in very low birth weight infants.

              AKI is associated with both increased short-term morbidity and mortality and greater long-term risk for CKD. This study determined the prevalence of AKI among very low birth weight infants using a modern study definition, evaluated the frequency of AKI diagnosis reporting in the discharge summary, and determined whether infants were referred to a pediatric nephrologist for AKI follow-up.
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                Author and article information

                Contributors
                euisjung@amc.seoul.kr
                Journal
                BMC Nephrol
                BMC Nephrol
                BMC Nephrology
                BioMed Central (London )
                1471-2369
                19 October 2020
                19 October 2020
                2020
                : 21
                : 437
                Affiliations
                [1 ]GRID grid.413967.e, ISNI 0000 0001 0842 2126, Department of Pediatrics, , University of Ulsan College of Medicine, Asan Medical Center, ; 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 South Korea
                [2 ]GRID grid.289247.2, ISNI 0000 0001 2171 7818, Department of Pediatrics, , Kyung Hee University School of Medicine, ; Seoul, South Korea
                Author information
                http://orcid.org/0000-0003-0693-5627
                Article
                2092
                10.1186/s12882-020-02092-1
                7570022
                33076845
                864d8129-cb0a-4528-9dea-dc8ce8b5a462
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 21 October 2019
                : 7 October 2020
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Nephrology
                acute kidney injury,infants,extremely low birth weight,peritoneal dialysis,hyperkalemia
                Nephrology
                acute kidney injury, infants, extremely low birth weight, peritoneal dialysis, hyperkalemia

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