Evaluation of continuous blood purification in clinical management of critically ill neonates / 中华围产医学杂志

ABSTRACT

Objective To explore the efficacy and safety of bedside continuous blood purification (CBP) in the treatment of critically ill neonates.Methods Totally ten critically ill neonates were hospitalized in Department of Neonatal Intensive Care Unit (NICU) in Shanghai Children's Hospital from June 2011 to May 2015, and managed with CBP treatment.The indications of CBP therapy were multiple organ dysfunction syndrome (MODS) failed to conventional treatment or combined with acute renal failure (ARF).The model for CBP was continuous veno-venous hemofiltration dialysis (CVVH).The clinical outcomes included blood electrolytes, serum bio markers, urine output, hemodynamic indicators, dose of intravenous epinephrine before treatment, 6, 12, 24, 48 h after treatment and at the end of CBP.Complications of CBP were also observed.Statistical analysis was performed with ANOVA and Dunnett-t test.Results The underlying problems of the ten newborns were septicemia (n=5), severe neonatal asphyxia (n=2), congenital hereditary metabolic disease (n=2) and traumatic asphyxia (n=l).The venous catheter was successfully inserted for all babies and CBP treatment continued for (86.7 ± 25.9) h averagely with obvious effect.Four of the ten cases were cured and discharged, and the rest six refused to treatment and died after due to irreversible injury of the nervous system although they had survived from the oliguric stage of ARF.The complications of CBP included thrombocytopenia (n=3), catheter blockage (n=2), hypotension (n=l).No hypothermia, thrombosis, bleeding or infection occurred.The mean blood pressure and partial pressure of oxygen in arterial blood/fraction of inspiration oxygen (PaO2/ FiO2) of the ten cases 6 h after the beginning of treatment were higher than those before [(46.4 ± 7.5) vs (36.5 ±8.3) mmHg, 1 mmHg=0.133 kPa;(210.0±62.0) vs (93.0±43.0) mmHg;t=2.647 and 6.378, both P ＜ 0.05].At the 12th hour since treatment start, the blood pH value was 7.4 ± 0.2, which was higher than that before treatment (6.9 ± 0.2, t=2.731, P ＜ 0.05), and kept in normal range.At the 24th hour, the serum levels of potassium, urea nitrogen and creatinine dropped to normal range compared to those before treatment [(4.8±2.9) vs (9.6± 3.6) mmol/L;(7.2±2.3) vs (13.6±6.3) mmol/L;(51.0± 12.0) vs (172.0±23.0) μ mol/L;t=4.571, 5.427 and 21.672, all P ＜ 0.05].Urine output increased from zero before the treatment to (0.7±0.3) ml/(kg · h) after 24 h (t=3.284, P ＜ 0.05).The maintaining dose of intravenous epinephrine decreased since 12 h after the beginning of treatment and was ceased at the 48th hour.Conclusion CBP is an effective and feasible treatment for critically ill neonates.