Systemic to Pulmonary Collaterals in Extremely Low Birth Weight Infants: Incidence, Clinical Significance, and Hemodynamic Features

2019 ◽  
Author(s):  
Cynthia Hayek ◽  
Rowena Cayabyab ◽  
Ima Thompson ◽  
Mahmood Ebrahimi ◽  
Bijan Siassi ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Clinical Outcomes ◽  
Left Ventricular ◽  
Extremely Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Echocardiographic Parameters ◽  
Group 2 ◽  
The Right ◽  
Group 1

Abstract Objective To determine the incidence of systemic to pulmonary collaterals (SPCs) in extremely low birth weight infants and to assess its clinical and hemodynamic significance beyond the neonatal period. Study Design Retrospective cohort study was conducted on 61 infants with echocardiogram performed at the time of discharge to determine the presence of SPC and to measure the right and left ventricular outputs and left atrium to aortic ratio. We compared two groups: small or no SPC (Group 1) to moderate or large SPC (Group 2) on demographics, clinical outcomes, and echocardiographic parameters. Results Sixty-one infants were included. The incidence of SPC was 57%; 21% of infants had moderate or large shunts and 31% had small SPC. Demographics, clinical outcomes, and echocardiographic parameters were not significantly different between small or no SPC and moderate to large SPC. Conclusion More than half of the infants had SPC. The size of the shunt did not affect the clinical outcomes nor the echocardiographic parameters measured. All infants had cardiac output above the normative mean.

scholarly journals Effects of Acute Peritoneal Dialysis in Extremely-Low-Birth-Weight Infants: A Retrospective Cohort Study

2019 ◽  
Author(s):  
Jihyun Noh ◽  
Chae Young Kim ◽  
Euiseok Jung ◽  
Joo Hoon Lee ◽  
Young-Seo Park ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Clinical Outcomes ◽  
Perinatal Asphyxia ◽  
Rescue Therapy ◽  
Insertion Site ◽  
Extremely Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Tertiary Center

Abstract Background :Acute peritoneal dialysis (APD) is a first-line rescue therapy for neonatal acute kidney injury (AKI) refractory to conservative management, but its efficacy in preterm infants remains unclear. This study aimed to investigate the clinical outcomes of APD and APD efficiency in extremely-low-birth-weight (ELBW) infants. Methods : We reviewed the medical records of inborn ELBW infants who underwent APD in a tertiary center. We recorded perinatal characteristics, including the causes of AKI and clinical outcomes. Serial input and output data and laboratory parameters to assess ultrafiltration/dialysis efficiency were also obtained. Results : A total of 12 ELBW infants were included in the study. Mean gestational age and birth weight were 27.2 weeks and 706.5 g, respectively. Leading cause of AKI was sepsis (50%) followed by perinatal asphyxia. Mean age at the start of PD was 16.3 days. Mean ultrafiltration (UF) rate was 2.73 mL/kg/h. After a mean duration of 9.4 days, the mean reduction in serum BUN and Cr levels was 42.5% and 20.1%, respectively. Mean sodium level increased from 135.8 to 144.7 mg/mL, and mean potassium level decreased from 6.8 to 5.0 mg/mL. The most common complication was mechanical dysfunction of the catheter, including dialysate leakage via the insertion site (75%). Only two patients were successfully weaned off APD. The overall mortality rate was 92%. Conclusions : In ELBW infants with AKI, APD was an effective rescue therapy in terms of its ultrafiltration and dialysis efficiency, but not with respect to neonatal mortality. Indications for APD in ELBW infants should be individualized depending on the etiology of AKI.

scholarly journals Acute kidney injury in an extremely low birth weight infant with nephrolithiasis: a case report

2019 ◽  
Vol 25 (3) ◽  
pp. 166-172
Author(s):  
Rasa Garunkštienė ◽  
Rimutė Vaitkevičienė ◽  
Ieva Paulavičienė ◽  
Nijolė Drazdienė ◽  
Rimantė Čerkauskienė
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Kidney Injury ◽  
Extremely Low Birth Weight ◽  
Low Birth Weight Infants ◽  
Low Birth Weight Infant ◽  
The Right

Acute kidney injury is associated with mortality of very low birth weight infants and reduces their survival regardless of other factors. The kidneys in the extremely preterm infants are very immature and susceptible to environmental factors. Clinical conditions and medications are risk factors for acute kidney injury in these patients. Nephrolithiasis in preterm infants is an extremely rare phenomenon that usually manifests as a complication of nephrocalcinosis. This is a case report that describes several episodes of acute kidney injury in the first two months of age in an extremely low birth weight infant with kidney stones in the background. The main causes that led to acute kidney injury in this patient were persistent ductus arteriosus, sepsis and captopril. At one month of age, ultrasound detected calcinates in the right kidney. Within two weeks a large number of linear stones formed across the collecting duct system. Small calcinates still remained in the right kidney when the girl was half a year of the corrected age. The evaluation of a neonate who develops acute kidney injury requires a systematic approach. Early identification of the emerging risk factors and prevention of nephrolithiasis along with effective treatment can reduce the risk of developing acute kidney injury in very low birth weight infants.

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