Continuous Renal Replacement Therapy for Two Neonates With Hyperammonemia

Christopher Markham; Caroline Williams; Cory Miller; Dorothy K Grange; T Keefe Davis; Kenneth E Remy

doi:10.3389/fped.2021.732354

Continuous Renal Replacement Therapy for Two Neonates With Hyperammonemia

Front Pediatr. 2021 Nov 5:9:732354. doi: 10.3389/fped.2021.732354. eCollection 2021.

Authors

Christopher Markham¹, Caroline Williams¹, Cory Miller¹, Dorothy K Grange¹, T Keefe Davis¹, Kenneth E Remy^{1

2}

Affiliations

¹ Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States.
² Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, United States.

Abstract

Objectives: This study aims to assess the feasibility of using hemofiltration for ammonia clearance in low body weight infants with an inborn error of metabolism. Design: A study of two cases. Setting: Quaternary pediatric hospital (Saint Louis Children's Hospital) NICU and PICU. Patients: Infants <6 months of age with an ICD-9 diagnosis of 270.6 (hyperammonemia). Interventions: Continuous renal replacement therapy (CRRT). Measurements and Main Results: We measure serum ammonia levels over time and the rate of ammonia clearance over time. Continuous renal replacement therapy was more effective than scavenger therapy alone (Ammonul™) for rapid removal of ammonia in low weight infants (as low as 2.5 kg). Conclusions: Continuous renal replacement therapy is technically feasible in low weight infants with severe hyperammonemia secondary to an inborn error of metabolism.

Keywords: citrullinemia; hemodialysis; hyperammonemia; methylmalonic acidemia; neonate.

Publication types

Review