Rapid resolution of hyperammonemia in neonates using extracorporeal membrane oxygenation as a platform to drive hemodialysis
| Autor: | Jamie R. Robinson, Patricia C. Conroy, Peter H. Grubb, Daphne Hardison, John B. Pietsch, Harold N. Lovvorn, Rizwan Hamid |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_treatment Risk Assessment Severity of Illness Index Article Cohort Studies 03 medical and health sciences Extracorporeal Membrane Oxygenation 0302 clinical medicine Ammonia Renal Dialysis Severity of illness medicine Extracorporeal membrane oxygenation Humans Hyperammonemia 030212 general & internal medicine Referral and Consultation Survival rate Retrospective Studies business.industry Infant Newborn Obstetrics and Gynecology Retrospective cohort study Hospitals Pediatric Prognosis medicine.disease 3. Good health Survival Rate Logistic Models Treatment Outcome surgical procedures operative Anesthesia Pediatrics Perinatology and Child Health Cohort Female Hemodialysis business Peritoneal Dialysis 030217 neurology & neurosurgery Cohort study |
| Zdroj: | Journal of perinatology : official journal of the California Perinatal Association |
| ISSN: | 1476-5543 0743-8346 |
| DOI: | 10.1038/s41372-018-0084-0 |
| Popis: | Objective We aimed to clarify the impact of Extracorporeal Membrane Oxygenation (ECMO) as a platform to drive hemodialysis (HD) for ammonia clearance on outcomes of neonates with severe hyperammonemia. Study Design All neonates treated for hyperammonemia at a single children’s hospital between 1992 and 2016 were identified. Patient characteristics and outcomes were compared between those receiving medical management or ECMO/HD. Result Twenty-five neonates were treated for hyperammonemia, of which 13 (52%) received ECMO/HD. Peak ammonia levels among neonates treated with ECMO/HD were significantly higher than those medically-managed (1041 [IQR 902–1581] μmol/L versus 212 [IQR 110–410] μmol/L; p=0.009). Serum ammonia levels in the ECMO/HD cohort declined to the median of medically managed within 4.5 (IQR 2.9–7.0) hours and normalized within 7.3 (IQR 3.6–13.5) hours. All neonates survived ECMO/HD, and 9 (69.2%) survived to discharge. Conclusion ECMO/HD is an effective adjunct to rapidly clear severe hyperammonemia in newborns, reducing potential neurodevelopmental morbidity. |
| Databáze: | OpenAIRE |
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