Treating infants suffering from kidney complications with standard-sized dialysis machines has proven problematic due to accuracy issues with height and weight. Although the number of newborns dealing with kidney failure is fairly limited, a viable treatment option is still vital to their quality of life. An Italian research team, led by Dr. Claudio Ronco of the San Bortolo Hospital in Vicenza, has become the first to develop a miniaturized dialysis machine sufficient in treating babies under 22 lbs.
"This is a pretty major advance for the smallest infants," Dr. Bethany Foster, associate professor of pediatrics at the Montreal Children's Hospital in Canada, said in an accompanying commentary. "I can't imagine the baby they (treated) would have survived with the current technology. You have to be especially vigilant with very small babies because what you're often doing amounts to heroic treatment," Foster said. "We need to be careful that we don't just do things because we can."
The Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM) was first used back in August of last year to treat a 3-day-old infant weighing around 6.6 lbs., who was suffering from multiple organ failure, the Associated Press reported. Prior to the treatment, the infant’s condition was so severe that Ronco declared, “this baby was almost dead.” Following 25 days of dialysis treatment with the CARPEDIEM, the infant’s organ function was restored and she was discharged from the hospital with mild renal deficiency that did not require renal replacement therapy. So far around 10 newborns across Europe have been treated by the CARPEDIEM.
"We have shown how the technical challenges of providing CRRT can be overcome without relying on the adaptation of technology used in adult settings, and that a CRRT device designed specifically for use in neonates and small children can be used to safely and effectively treat acute kidney injury in small pediatric patients,” Ronco explained. “We hope that our success will encourage the development of other medical technologies specifically designed for infants and small children."
Currently, the standard form of treatment for infants less than 33 lbs. suffering from kidney failure involves a continuous renal replacement therapy (CRRT) machine. Waste products from the blood are removed via a catheter that is inserted into the abdomen. Unfortunately, newborns with low-birth weight are sometimes too small for this method to be effective. In some cases, too much fluid is withdrawn, leading to dehydration and a drop in blood pressure, or too little fluid is withdrawn, leading to high blood pressure and swelling caused by excess fluid.
Source: Ronco C, Garzotto F, Brendolan A, et al. Continuous renal replacement therapy in neonates and small infants: development and first-in-human use of a miniaturised machine (CARPEDIEM). The Lancet. 2014.