Continuous venovenous hemodiafiltration in the treatment of newborns with an inborn metabolic disease: a single center experience

Abstract

Background/aim: Most inborn metabolic diseases are diagnosed during the neonatal period. The accumulation of toxic metabolitesmay cause acute metabolic crisis with long-term neurological dysfunction and death. Renal replacement therapy (RRT) modalities allowthe efficient removal of toxic metabolites. In this study, we reviewed our experience with continuous venovenous hemodiafiltration(CVVHDF) as RRT for newborns with an inborn metabolic disease.Materials and methods: Patients diagnosed with an inborn metabolic disease and who received CVVHDF treatment at our neonatalintensive care unit between January 2014 and December 2017 were included in this study. Their demographic and clinical data werecollected, and the efficacy and safety of CVVHDF was evaluated.Results: A total of nine continuous RRT (CRRT) sessions as CVVHDF were performed in eight newborns with a diagnosis of urea cycledefect (n = 5), maple syrup urine disease (n = 2), or methylmalonic acidemia (n = 1). The mean age at admission was 10 ± 8.6 days(range: 3–28 days). The mean plasma levels of ammonium were 1120 ± 512.6 mg/dL and 227.5 ± 141.6 mg/dL before and at the endof the treatment, respectively. Plasma levels of leucine were 2053.5 ± 1282 μmol/L and 473.5 ± 7.8 μmol/L before and at the end of thetreatment, respectively. The CVVHDF duration was 32.3 ± 11.1 h (median: 37 h; range: 16–44 h), and the mean length of hospitalizationwas 14.6 ± 12.9 days. The mean duration of CVVHDF was 32.3 ± 11.1 h (range: 16–44 h). Circuit clotting was the most commonobserved complication (37.5%) and the survival rate was 50%. Among surviving patients, two developed severe and two developed mildmental and motor retardation.Conclusion: CVVHDF is a CRRT modality that can be used to treat newborns with an inborn metabolic disease. Early diagnosis,commencement of specific medical therapy, diet, and extracorporeal support, if needed, are likely to result in improved short and longtermoutcomes.