BACKGROUND: In severe neonatal hyperammonemia, extracorporeal dialysis (ECD) provides higher ammonium clearance than peritoneal dialysis (PD). However, there are limited outcome data in relation to dialysis modality. METHODS: Data from infants with hyperammonemia secondary to inborn errors of metabolism (IEM) treated with dialysis were collected in six Italian centers and retrospectively analyzed. RESULTS: Forty-five neonates born between 1990 and 2011 were enrolled in the study. Of these, 23 were treated with PD and 22 with ECD (14 with continuous venovenous hemodialysis [CVVHD], 5 with continuous arteriovenous hemodialysis [CAVHD], 3 with hemodialysis [HD]). Patients treated with PD experienced a shorter duration of predialysis coma, while those treated with HD had a shorter ammonium decay time compared with all the other patients (p < 0.05). No difference in ammonium reduction rate was observed between patients treated with PD, CAVHD or CVVHD. Carbamoyl phosphate synthetase deficiency (CPS) was significantly associated with increased risk of death (OR: 9.37 [1.52-57.6], p = 0.016). Predialysis ammonium levels were significantly associated with a composite end-point of death or neurological sequelae (adjusted OR: 1.13 [1.02-1.27] per 100 μmol/l, p = 0.026). No association was found between outcome and dialysis modality. CONCLUSIONS: In this study, a delayed ECD treatment was not superior to PD in improving the short-term outcome of neonates with hyperammonemia secondary to IEM.
Short-term survival of hyperammonemic neonates treated with dialysis / S. Picca, C. Dionisi-Vici, A. Bartuli, T. De Palo, F. Papadia, G. Montini, M. Materassi, M. Donati, E. Verrina, M. Schiaffino, C. Pecoraro, E. Iaccarino, E. Vidal, A. Burlina, F. Emma. - In: PEDIATRIC NEPHROLOGY. - ISSN 0931-041X. - 30:5(2015 May), pp. 839-847.
|Titolo:||Short-term survival of hyperammonemic neonates treated with dialysis|
|Parole Chiave:||continuous venovenous hemodialysis; inborn errors of metabolism; neonatal hyperammonemia|
|Settore Scientifico Disciplinare:||Settore MED/38 - Pediatria Generale e Specialistica|
|Data di pubblicazione:||mag-2015|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1007/s00467-014-2945-x|
|Appare nelle tipologie:||01 - Articolo su periodico|