Continuous renal replacement therapy in neonates with multiple organ dysfunction syndrome: clinical utilization effects and outcomes.

Background: The use of continuous renal replacement therapy (CRRT) has expanded from children to neonates. In addition to acute kidney injury (AKI), it is also used in critically ill neonates with hyperammonemia, sepsis, and multiple organ dysfunction syndromes (MODS).

Methods: We retrospectively analyzed clinical data of 52 neonates with MODS treated with CRRT at two tertiary hospitals. Hemodynamic parameters, hepatic and renal function were recorded before CRRT, 12, 24 h after CRRT initiation, and at the end of CRRT, respectively. Further analysis of mortality factors in neonates with MODS treated with CRRT was performed.

Results: (1) The most common primary diseases of 52 critically ill neonates with MODS were neonatal asphyxia, neonatal sepsis and inborn errors of metabolism (IEM). The median number of organs involved was 4.0 (3.0, 5.0), with the respiratory system, cardiovascular system and kidneys being the most commonly involved organs. (2) Compared to pre-CRRT, the mean arterial pressure (MAP), lactate, serum creatinine (SCr), blood urea nitrogen (BUN), and urine output of neonates with MODS were significantly improved at 12 h of CRRT. Vasoactive inotropic score (VIS) and pH improved significantly at 24 h of CRRT. (3) The overall mortality rate of 52 critically ill neonates with MODS was 38.5%. Risk factors associated with death included primary disease, number of organs involved, the neonatal critical illness score (NCIS), MAP, lactate and urine output. Multi-factorial logistic regression analysis showed that NCIS was an independent risk factor for death in neonates with MODS treated with CRRT.

Conclusions: Mortality of critically ill neonates with MODS who receiving CRRT remains high, and NCIS is an independent risk factor for their deaths. CRRT may be a safe and effective adjunctive therapy for critically ill neonates with MODS.