Peritoneal Dialysis in Neonates with Extremely Low Body Weight at Birth: New Modality of Using IV Cannula for Peritoneal Access

Extremely low birth weight (ELBW) is defined as a birth weight less than 1000g. Acute kidney failure (AKF) is registered in 6%-24% of critically ill neonates treated at the intensive care units (ICU). The primary causes of AKF in these neonates are prerenal mechanisms (around 85%), which include hypovolemia, hypotension and hypoxemia. A medication therapy is applied first and in case it does not yield the desired results, a renal replacement therapy is applied[1,2]. Peritoneal dialysis (PD) is generally regarded as the optimal dialysis modality for neonates[3]. PD allows for the slow removal of fluid and solutes while avoiding hemodynamic instability. Peritoneal dialysis is a relatively safe, simple and effective procedure, which can be accomplished with a minimum of equipment and for its efficient use a highly trained team is not essential[4]. There are two main types of PD: continuous ambulatory peritoneal dialysis (CAPD) where the fluid exchanges are made manually. Gravity makes the filling and draining process possible. More sophisticated variant of CAPD is continuous cycling peritoneal dialysis (CCPD) commonly referred to as automated peritoneal dialysis (APD) uses an automated machine called cyler to perform fluid exchanges. APD is not used in ELBW so far, because the minimum loading volume that supports this machine is 100 ml, and because of low body weight, filling volume in ELBW neonates are much smaller