Acute peritoneal dialysis in very low birth weight neonates using a vascular catheter.

We report on our experience with acute peritoneal dialysis (APD) in 16 very low birth weight neonates ranging from 24.6 to 30.2 weeks' gestation with a birth weight ranging from 630 g to 1,430 g using a 14-gauge Arrow vascular catheter for APD access. The underlying causes of acute renal failure were: sepsis (7), necrotizing enterocolitis (4), patent ductus arteriosus (3), hydrops fetalis (1), intracranial hemorrhage (3), pulmonary hemorrhage (2), pneumonia (1), and perinatal asphyxia (1). Among 12 patients, the APD was successful for the control of hyperkalemia, fluid overload, and metabolic acidosis. The peritoneal permeability and transport were at their maximum at a short dwell time with rapid exchanges. Complications associated with the APD were: peritonitis (2), leakage (2), hemoperitoneum (1), and hernia (1). During the dialysis, four patients died; there were three episodes of catheter-related complications in these patients. At 60 days after the withdrawal of the APD, 10 patients were alive, and had full recovery of their renal function. Therefore, APD in premature neonates with a 14-gauge Arrow vascular catheter was safe and effective. This procedure helped manage the hemodynamic and metabolic imbalance of acute renal failure and was associated with few complications.