Continuous renal replacement therapy (CRRT) has become the preferred modality for the management of critically ill children with acute kidney injury (AKI) and fluid overload. Recently a new paediatric CRRT system (CARPEDIEM, Bellco, Mirandola, Italy) has become available to treat newborns and small infants (weight range 2,0-9,9kg). Here we describe the first case of successful CRRT treatment with CARPEDIEM in a preterm 1,8kg body-weight newborn affected by Di George syndrome, who developed AKI after cardiac surgery.
Continuous Veno-Venous Hemofiltration (CVVH) was delivered by the CARPEDIEM system. Changes in blood pressure, heart rate, blood gas, electrolyte, hemoglobulin (Hb), and hematocrit (Hct) were closely monitored.
After cardiac surgery for interrupted aortic arch (type-B) and interventricular septal defect, a 3-weeks-old newborn developed abrupt decrease in renal function with diminished urine output and oedema. To treat acute renal injury and fluid overload a 4-fr central venous catheter was placed in the right internal jugular vein and a renal replacement therapy with CVVH for four days was carried out. As hemofilter a polysulphone membrane with a surface area of 0,150m2 was employed. Priming of the extracorporeal circuit was performed with packed red blood cells to stabilize the hematocrit and to maintain hemodynamic stability. Blood flow was at 15ml/h, while mean ultrafiltration was 30ml/kg/h for 10h (range 5-24) daily. Due to high hemorrhagic risk, anticoagulation with heparin at 5IU/kg/h was used with no bleeding complications. The patient was cared under a radiant warmer to prevent hypothermia.
After 4-days treatment CVVH was discontinued due to urine output recovery and fluid overload correction. After a 50-days hospitalization, the patient was discharged with normal renal function.
This case demonstrates that CVVH with CARPEDIEM system provides good hemodynamic tolerance and correction of fluid overload in very low-body weight critically ill children with AKI.
