Chronic dialysis in the infant less than 1 year of age

Show simple item record Bunchman, Timothy E. en_US 2006-09-11T19:26:56Z 2006-09-11T19:26:56Z 1995-01 en_US
dc.identifier.citation Bunchman, Timothy E.; (1995). "Chronic dialysis in the infant less than 1 year of age." Pediatric Nephrology 9(1): S18-S22. <> en_US
dc.identifier.issn 1432-198X en_US
dc.identifier.issn 0931-041X en_US
dc.identifier.uri en_US
dc.description.abstract Dialysis in the infant carries a mortality rate of 16%. Institution of dialysis may be the result of adequate nutritional intake, but avoidance of nutritional intake should never be seen as a way to prevent dialysis. Increased caloric intake, usually via enteral feeding tubes, is needed for optimal growth in the infant with end-stage renal disease (ESRD) in order to attain adequate nutrition with resulting good growth. “Renal” formulae may be constituted as dilute (as in the polyuric infant) or concentrated (as in the anuric infant) to fit the infants needs. Peritoneal dialysis (PD) is the usual mode of renal replacement therapy (97%), with access via a surgically placed cuffed catheter with attention to the placement of the exit site in order to avoid fecal or urinary contamination. PD volumes of 30–40 ml/kg per pass or 800–1,200 ml/m 2 per pass usually result in dialysis adequacy. Additional dietary sodium (3–5 mEq/kg per day) and protein (3–4 g/kg per day) are needed, due to sodium and protein losses in the dialysate. Protein losses are associated with significant infectious morbidity and nonresponsiveness to routine immunizations. Hemodialysis (HD) can be performed either as single- or dual-needle access that have minimal dead space (less then 2 ml) and recirculation rate (less then 5%). Attnetion to extracorporeal blood volume (<10% of intravascular volume), blood flow rates (3–5 ml/kg per min), heparinization (activated clotting times), ultrafiltration (ultrafiltration monitor), and temperature control is imperative during each treatment. Because infants' nutrition is mostly fluid, HD may be needed 4–6 days/week (especially in the oligoanuric infant) to avoid excessive volume overload between treatments. At the end of the treatment a slow blood return with minimal saline rinse is needed to avoid hemodynamic compromise. Infant dialysis, although technically challenging with a significant morbidity and mortality rate, can be safely carried out in the infant with ESRD but requires infant-specific equipment and trained personnel. en_US
dc.format.extent 598537 bytes
dc.format.extent 3115 bytes
dc.format.mimetype application/pdf
dc.format.mimetype text/plain
dc.language.iso en_US
dc.publisher Springer-Verlag; IPNA en_US
dc.subject.other Medicine & Public Health en_US
dc.subject.other Chronic Dialysis en_US
dc.subject.other Infants Under 1 Year en_US
dc.subject.other Pediatrics en_US
dc.title Chronic dialysis in the infant less than 1 year of age en_US
dc.type Article en_US
dc.subject.hlbsecondlevel Public Health en_US
dc.subject.hlbsecondlevel Pediatrics en_US
dc.subject.hlbsecondlevel Internal Medicine and Specialties en_US
dc.subject.hlbtoplevel Health Sciences en_US
dc.description.peerreviewed Peer Reviewed en_US
dc.contributor.affiliationum Department of Pediatric Nephrology and Critical Care, University of Michigan, 1521 Simpson Road East, Box 0297-L2602, 48109, Ann Arbor, Michigan, USA en_US
dc.contributor.affiliationumcampus Ann Arbor en_US
dc.identifier.pmid 7492480 en_US
dc.description.bitstreamurl en_US
dc.identifier.doi en_US
dc.identifier.source Pediatric Nephrology en_US
dc.owningcollname Interdisciplinary and Peer-Reviewed
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