Title:
Experiences with CVVH as a new treatment modality in our paediatric and neonatal ICU

L. Koster-Kamphuis¹ ;L. Koster-Kamphuis¹

1. University Children’s Hospital St Radboud Nijmegen

E-mail address corresponding author:
l.koster@cukz.umcn.nl

Background:
For a long time acute peritoneal dialysis was the renal replacement therapy (RRT) of choice in the neonatal and paediatric intensive care units. Sometimes CAVH was used also. Newer techniques and materials suitable for use in (small) children have changed possible modalities of RRT in the neonatal and paediatric intensive care unit. The aim is to describe our first experiences with CVVH as a new treatment modality in our paediatric and neonatal intensive care units.

Methods:
Between March 2003 and January 2005 fourteen patients were treated with CVVH. Their age was between three days and almost twelve years. Their weight was between 2,2 and 40 kg. In our children’s hospital the PRISMA (Gambro BV) is used. Three infants were treated in combination with Extra Corporeal Membrane Oxygenation (ECMO). The M 10 filter was used five times, the M 60 filter eight times and the M 100 filter once. Treatment modality was CVVH nine times, CVVHDF five times. Vascular access was achieved through a dual lumen catheter in the femoral vein (n=6), jugular vein (n=2), subclavian vein (n=1), pulmonary artery (n=1), umbilical catheters (n=1), through the ECMO circuit (n=3). In almost all cases heparin was used as anticoagulant. The treatment time varied between three hours and ten days. Indication to start CVVH was acute renal failure with fluid overload (n=5), multiple organ failure (n=4), severe hyperammonemia (n=3), fluid overload (n=2). Underlying disorders were congenital heart defect (n=5), inborn error of metabolism (n=3), malignancy (n=2), faecal peritonitis (n=1), congenital diaphragmatic hernia (n=1), sepsis (n=1) and respiratory insufficiency of unknown cause (n=1).

Results:
Therapy failed three times due to inadequate vascular access. One child died before alternative RRT was started. In one child several days’ later vascular access was still achieved. One child was treated with peritoneal dialysis. In this child CVVH was started in a second episode of renal failure. This time the treatment succeeded. Five of the fourteen children died. One child died short after starting CVVH due to cerebral herniation. In one child all treatment was discontinued. One child died because of multiple complications not related to CVVH. One child died 16 days after CVVH treatment due to respiratory failure. One child died due to multiple organ failure. Nine patients recovered well and were discharged from the intensive care.

Conclusion:
CVVH is a new treatment modality in our paediatric and neonatal intensive care units. Its offers more expanded treatment options for very ill (small) children. Adequate vascular access is the most important condition for a successful treatment.

Subject:
Hemodiafiltration

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