Peritoneal dialysis for acute renal failure in premature infants

Objective To investigate the effectiveness and safety of peritoneal dialysis(PD) in premature infants with acute renal failure(ARF). Methods In the neonatal intensive care unit (NICU) of Guangdong Province Maternal and Children Hospital, 12 premature infants underwent continuous PD due to ARF from March 2012 to March 2015, without using any antibiotics in the dialysis fluid. Before and after dialysis, the changes of serum urea nitrogen, creatinine, potassium and pH were compared. The complications (blockage, leakage, infection and necrotizing enterocolitis) and gastrointestinal nutrition situation were observed. Wilcoxon signed rank sum test was used for statistical analysis. Results Among the 12 premature infants, the underlying causes of ARF were sepsis (n=9), perinatal asphyxia (n=2), twin-twin transfusion syndrome (n=1). The average gestational age was (30.9±3.2) weeks, the average body weight (before PD) was (1 461±525) g, the duration of PD was (3.8±2.6) d. Complications associated with PD included leakage (n=3) and peritonitis (n=2) in which Candids albicans and Klebsiella pneumonia were identified in ascites. Gastrointestinal nutrition was built up in six cases within one to four days after dialysis, among which one developing necrotizing enterocolitis on the 7th d after feeding. Finally, eight babies died (six died after initiative discontinued treatment and two died because of critically illness) and four patients were cured and discharged. Lower serum urea nitrogen and potassium levels and higher pH value were shown after dialysis than before [(9.16±3.15) vs (12.71±6.98) mmol/L; (4.36±0.82) vs (6.24±1.72) mmol/L; 7.32±0.17 vs 7.21±0.17; Z=-2.118, -2.197 and -2.981, all P<0.05). Conclusion PD is an alternative safe and effective treatment for premature infants with ARF due to its simplicity both in manipulation and equipment requirement. Key words: Acute kidney injury; Peritoneal dialysis; Infant, premature