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Continuous Renal Replacement Therapy in Preterm Infants

Yonsei Medical Journal 2019년 60권 10호 p.984 ~ 991
 ( Noh Eu-Seon ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics

 ( Kim Hyun-Ho ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics
 ( Kim Hye-Seon ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics
 ( Han Yea-Seul ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics
 ( Yang Mi-Sun ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics
 ( Ahn So-Yoon ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics
 ( Sung Se-In ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics
 ( Chang Yun-Sil ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics
 ( Park Won-Soon ) - Sungkyunkwan University School of Medicine Samsung Medical Center Department of Pediatrics

Abstract


Purpose: Despite the increasing use of continuous renal replacement therapy (CRRT) in the neonatal intensive care unit (NICU), few studies have investigated its use in preterm infants. This study evaluated the prognosis of preterm infants after CRRT and identified risk factors of mortality after CRRT.

Materials and Methods: A retrospective review was performed in 33 preterm infants who underwent CRRT at the NICU of Samsung Medical Center between 2008 and 2017. Data of the demographic characteristics, predisposing morbidity, cardiopulmonary function, and CRRT were collected and compared between surviving and non-surviving preterm infants treated with CRRT. Univariable and multivariable analyses were performed to identify factors affecting mortality.

Results: Compared with the survivors, the non-survivors showed younger gestational age (29.3 vs. 33.6 weeks), lower birth weight (1359 vs. 2174 g), and lower Apgar scores at 1 minute (4.4 vs. 6.6) and 5 minutes (6.5 vs. 8.6). At the initiation of CRRT, the non-survivors showed a higher incidence of inotropic use (93% vs. 40%, p=0.017) and fluid overload (16.8% vs. 4.0%, p=0.031). Multivariable analysis revealed that fluid overload >10% at CRRT initiation was the primary determinant of mortality after CRRT in premature infants, with an adjusted odds ratio of 14.6 and a 95% confidence interval of 1.10?211.29.

Conclusion: Our data suggest that the degree of immaturity, cardiopulmonary instability, and fluid overload affect the prognosis of preterm infants after CRRT. Preventing fluid overload and earlier initiation of CRRT may improve treatment outcomes.

키워드

Continuous renal replacement therapy; premature infants; fluid overload
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