Current Practice of Kidney Support Therapy in the NICU: Results from a CHNC Survey.

Abstract

In a survey conducted within the Children's Hospital Neonatal Consortium (CHNC), the Kidney Focus Group aimed to describe the resource and practice variations among participating level IV neonatal intensive care units.A 24-question survey was developed by neonatologists and pediatric nephrologists who belong to the Kidney Support Therapy (KST) subgroup of the CHNC Kidney Focus Group.The majority (89.5%) of responding centers offered some form of KST, with > 90% centers offered prenatal consultations. The most common KST modality offered were peritoneal dialysis (PD) and continuous renal replacement therapy (CRRT) while on ECMO. Prismaflex was the most common device used for stand-alone CRRT. The most common indication for KST initiation was fluid overload and body weight was indicated as the most common limiting factor with the majority of centers reporting weight limitation ≤ 1.5-2 kg.Advances in technology have made it possible to offer KST to a wider neonatal population than before. However, the availability of such technologies can vary significantly among institutions in addition to diversity of clinical experience and standardized protocols. This survey provides valuable insights into current KST practices across 19 level IV NICUs within the CHNC demonstrating expected practice variations amongst centers that may be dependent on location, center resources, and subspecialty providers, among others. · Considerable practice variation exists in KST among NICUs.. · Majority of NICUs utilize multi-disciplinary involvement, but subspecialties vary widely.. · The most common indication for KST initiation was fluid overload..