The Effect of dialysis rate on continuous renal replacement therapy for neonatal hyperammonemia

Abstract

Abstract Background CRRT has attracted more and more attention in the treatment of acute neonatal hyperammonemia. Methods We retrospectively analyzed the clinical data of hyperammonemic neonates treated with CRRT in the neonatal intensive care unit (NICU) of Shanghai Children's Hospital from August 2016 to September 2021, and further explored the relationship between the rate of decrease of blood ammonia and dialysis rate. Results A total of 6 cases of neonatal hyperammonemia were included, their primary diseases were 3 cases of ornithine transcarbamyltransferase deficiency (OTCD), 1 case of carbamoyl phosphate synthetase 1 deficiency (CPS1D), 1 case of methylmalonic acidemia (MMA) with homocysteinemia (combined MMA) and 1 case of transient hyperammonemia. All infants developed impaired consciousness, convulsions and severe hyperammonemia, so CRRT was superimposed on diet control and medication, and the mode of continuous venovenous hemodiafiltration (CVVHDF) was used in all cases. The gestational age at birth was (37.98 ± 1.12) weeks, the age at onset was (1.91 ± 0.91) d, and the weight at CRRT was (3157.50 ± 605.95) g. The dialysis rate was (880–3937) ml/h/1.73m2, the decrease rate of blood ammonia was (15.79–33.33) µmol/h, and the duration of CRRT diversion was 44–110 h. The decrease rate of blood ammonia increased with the increase in dialysis rate, without an increase in the incidence of serious complications. Conclusions CRRT can alleviate the metabolic crisis of hyperammonemic neonates, and increasing the dialysis rate of CRRT can safely and more effectively reduce blood ammonia levels in critically hyperammonemic neonates.