Author Of 2 Presentations
BLOOD PRODUCT (BP) REQUIREMENTS IN NEONATES ON VENO-VENOUS CONTINUOUS RENAL REPLACEMENT THERAPY (VV-CRRT) DUE TO RENAL OLYGOHYDRAMNIOS (ROH).
Abstract
Background
Treatment of neonates with renal ROH and complete “potter sequence” is challenging. Mortality remains high.
Objectives
Report BP requirements in neonates on VV-CRRT due to ROH during the first 16 days of life. Compare neonates < 3kg to > 3kg birth weight.
Methods
Retrospective data review of 5 patients with ROH. VV-CRRT was initiated between day 0 and 4 of life. Prismaflex with HF 20 Filter was used. Anticoagulation was accomplished with low dose citrate (2,5-3 mmol/l), Epoprostenol 4- 10 ng/kg/min) and Heparin 5- 10 IE/kg/h. Coagulation goals were defined as ACT 160- 180, fibrinogen > 150 mg/d, ATIII > 40 % Thrombocytes > 30000, HCT > 35 %. All administered, body weight adjusted, units of BP were noted.
Results
Pathologies were ARPKD (n=1), urethral valve (n=2), and renal dysplasia (n=2). Patients 2 < 3kg (2,2- 2,8), and 3 > 3kg (3 -3,8). No Bleeding episodes occurred. Filter running time < 3kg 32h (11- 109) > 3kg 58h (10- 124). Filter change, including planned down time 7 /6 in > 3 kg. Blood- products administered: Fibrinogen < 3kg 8,5 (7-10) opposed to 4 (1-4) > 3kg, ATIII 7 / 2(1-3) thrombocytes 7,5 (7-8) /2 (0-4) and packed red blood 6,5 (6-7)/ 3 (3-8). Most administrations occurred during blood prime after planned or unplanned filter change.
Conclusion
Neonates < 3kg had shorter filter running times and needed excessively more BPs. Longer filter running times seem to be associated with less BP requirements. There is a need for standardised management especially frugal laboratory testing.
TRIPLE ANTICOAGULATION IN NEONATAL VENO-VENOUS CONTINUOUS RENAL REPLACEMENT THERAPY (VV-CRRT, PRISMAFLEX®)
Abstract
Background
Neonates with renal oligohydramnion (ROH) who require a complex intensive-care management including extensive ventilation strategies due to lung-hypolasia and hemodynamic support are therefore in need of a stable CRRT procedure. Anticoagulation for CRRT in neonates is of high importance to provide stable blood flow and long filter running time.
Objectives
Aim of the analysis is a proof of concept of triple anticoagulation in neonatal VV-CRRT.
Methods
Retrospective data analysis including 5 neonates with ROH. VV-CRRT was performed with Prismaflex® (HF 20 Filter Set, blood priming) via a jugular central venous line ( 5.5-6French), started on day 0-4. Anticoagulation was managed with low-dose Citrate (2.5-3mmol/l), Epoprostenol (5-10ng/kg/min) and Heparin (5-10 IE/kg/h). Bedside ACT was used to titrate Heparin. Adverse events were noted.
Results
5 Neonates, median 37+/-2 weeks of gestation and 3014g (+/-736g) birth weight. Primary disease of ROH were ARPKD (n=1), bilateral renal dysplasia (n=1), BOR syndrome (n=1), posterior urethral valve (n=2). Within median 16d of VV-CRRT (dialysis hours median 300.4+/-57.7) 7 filters with a median filter running time of 46h (range 10-109) were needed. Mean blood flow 13.8ml/h (range 10-16), dialysis dose 97ml/kg/h (+/-55.8; range 48.4-198), UFR 7.27ml/kg/h (+/-1.78; range 5.1-9.7), CaT/CaJ 1.34 (+/-0.3). No bleeding events occurred, ACT goals 160-180 achieved.
Conclusion
Triple anticoagulation as mentioned above with strict ranges is feasible in neonatal VV-CRRT without adverse events (e.g. bleeding) and enables a stable filter running time with less unplanned shutdown as well as a stable low blood flow in a dialysis-equipment primarily built up for adults and adolescents.
Presenter of 1 Presentation
BLOOD PRODUCT (BP) REQUIREMENTS IN NEONATES ON VENO-VENOUS CONTINUOUS RENAL REPLACEMENT THERAPY (VV-CRRT) DUE TO RENAL OLYGOHYDRAMNIOS (ROH).
Abstract
Background
Treatment of neonates with renal ROH and complete “potter sequence” is challenging. Mortality remains high.
Objectives
Report BP requirements in neonates on VV-CRRT due to ROH during the first 16 days of life. Compare neonates < 3kg to > 3kg birth weight.
Methods
Retrospective data review of 5 patients with ROH. VV-CRRT was initiated between day 0 and 4 of life. Prismaflex with HF 20 Filter was used. Anticoagulation was accomplished with low dose citrate (2,5-3 mmol/l), Epoprostenol 4- 10 ng/kg/min) and Heparin 5- 10 IE/kg/h. Coagulation goals were defined as ACT 160- 180, fibrinogen > 150 mg/d, ATIII > 40 % Thrombocytes > 30000, HCT > 35 %. All administered, body weight adjusted, units of BP were noted.
Results
Pathologies were ARPKD (n=1), urethral valve (n=2), and renal dysplasia (n=2). Patients 2 < 3kg (2,2- 2,8), and 3 > 3kg (3 -3,8). No Bleeding episodes occurred. Filter running time < 3kg 32h (11- 109) > 3kg 58h (10- 124). Filter change, including planned down time 7 /6 in > 3 kg. Blood- products administered: Fibrinogen < 3kg 8,5 (7-10) opposed to 4 (1-4) > 3kg, ATIII 7 / 2(1-3) thrombocytes 7,5 (7-8) /2 (0-4) and packed red blood 6,5 (6-7)/ 3 (3-8). Most administrations occurred during blood prime after planned or unplanned filter change.
Conclusion
Neonates < 3kg had shorter filter running times and needed excessively more BPs. Longer filter running times seem to be associated with less BP requirements. There is a need for standardised management especially frugal laboratory testing.