Extracorporeal dialysis in neonatal hyperammonemia : modalities and prognostic indicators
We investigated the prognostic indicators in ten hyperammonemic neonates: four treated by continuous arteriovenous hemodialysis (CAVHD), four with continuous venovenous hemodialysis (CVVHD), and two with hemodialysis (HD). Plasma ammonium levels decreased significantly within the first 24 h irrespec...
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| Veröffentlicht in: | Pediatric nephrology (Berlin, West) West), 2001-11, Vol.16 (11), p.862-867 |
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| creator | PICCA, Stefano DIONISI-VICI, Carlo ABENI, Damiano PASTORE, Anna RIZZO, Cristiano ORZALESI, Marcello SABETTA, Gaetano RIZZONI, Gianfranco BARTULI, Andrea |
| description | We investigated the prognostic indicators in ten hyperammonemic neonates: four treated by continuous arteriovenous hemodialysis (CAVHD), four with continuous venovenous hemodialysis (CVVHD), and two with hemodialysis (HD). Plasma ammonium levels decreased significantly within the first 24 h irrespective of dialysis modality (from 1419 to 114 micromol/l, median values; P |
| doi_str_mv | 10.1007/s004670100702 |
| format | Article |
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Plasma ammonium levels decreased significantly within the first 24 h irrespective of dialysis modality (from 1419 to 114 micromol/l, median values; P<0.0001). CVVHD achieved the highest ammonium clearance. HD provided highest ammonium extraction but clearance was hampered by severe hemodynamic instability. Five patients had a good outcome (normal at follow-up of 9-59 months), five had poor outcome (four died and one has severe neurological damage). Total coma duration was shorter in patients who had a good outcome (47+/-11 vs 78+/-13 h; P=0.02). Remarkably, only coma duration before dialysis determined this difference (22.2+/-10.1 vs 48.8+/-11.2 h; P=0.02). In cases with good outcome, coma duration was <33 h, whereas the others exceeded this limit. The prognosis was not related to dialysis modality, rapidity in reducing ammonium levels or to the underlying metabolic defect. In conclusion, results showed CVVHD to be the optimal modality for extracorporeal ammonium detoxification. However, the most relevant indicator for prognosis was coma duration before the start of dialysis. Therefore, major efforts should be made to refer patients quickly to highly specialized centers.</description><identifier>ISSN: 0931-041X</identifier><identifier>EISSN: 1432-198X</identifier><identifier>DOI: 10.1007/s004670100702</identifier><identifier>PMID: 11685590</identifier><identifier>CODEN: PENED3</identifier><language>eng</language><publisher>Heidelberg: Springer</publisher><subject>Amino acids ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; Coma ; Coma - etiology ; Coma - physiopathology ; Emergency and intensive care: renal failure. Dialysis management ; Glutamine - blood ; Hemodialysis ; Humans ; Hyperammonemia - blood ; Hyperammonemia - complications ; Hyperammonemia - mortality ; Hyperammonemia - therapy ; Infant, Newborn ; Intensive care medicine ; Medical prognosis ; Medical sciences ; Patients ; Peritoneal dialysis ; Plasma ; Prognosis ; Proteins ; Quaternary Ammonium Compounds - blood ; Renal Dialysis - methods ; Time Factors ; Venous access</subject><ispartof>Pediatric nephrology (Berlin, West), 2001-11, Vol.16 (11), p.862-867</ispartof><rights>2002 INIST-CNRS</rights><rights>IPNA - International Pediatric Nephrology Association New York, USA 2001</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c346t-8bef7309dbb67052d9be30c80bb49cc7f46e2d30254be924076b0fc391ec0b6e3</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>309,310,314,776,780,785,786,23909,23910,25118,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=14107173$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/11685590$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>PICCA, Stefano</creatorcontrib><creatorcontrib>DIONISI-VICI, Carlo</creatorcontrib><creatorcontrib>ABENI, Damiano</creatorcontrib><creatorcontrib>PASTORE, Anna</creatorcontrib><creatorcontrib>RIZZO, Cristiano</creatorcontrib><creatorcontrib>ORZALESI, Marcello</creatorcontrib><creatorcontrib>SABETTA, Gaetano</creatorcontrib><creatorcontrib>RIZZONI, Gianfranco</creatorcontrib><creatorcontrib>BARTULI, Andrea</creatorcontrib><title>Extracorporeal dialysis in neonatal hyperammonemia : modalities and prognostic indicators</title><title>Pediatric nephrology (Berlin, West)</title><addtitle>Pediatr Nephrol</addtitle><description>We investigated the prognostic indicators in ten hyperammonemic neonates: four treated by continuous arteriovenous hemodialysis (CAVHD), four with continuous venovenous hemodialysis (CVVHD), and two with hemodialysis (HD). Plasma ammonium levels decreased significantly within the first 24 h irrespective of dialysis modality (from 1419 to 114 micromol/l, median values; P<0.0001). CVVHD achieved the highest ammonium clearance. HD provided highest ammonium extraction but clearance was hampered by severe hemodynamic instability. Five patients had a good outcome (normal at follow-up of 9-59 months), five had poor outcome (four died and one has severe neurological damage). Total coma duration was shorter in patients who had a good outcome (47+/-11 vs 78+/-13 h; P=0.02). Remarkably, only coma duration before dialysis determined this difference (22.2+/-10.1 vs 48.8+/-11.2 h; P=0.02). In cases with good outcome, coma duration was <33 h, whereas the others exceeded this limit. The prognosis was not related to dialysis modality, rapidity in reducing ammonium levels or to the underlying metabolic defect. In conclusion, results showed CVVHD to be the optimal modality for extracorporeal ammonium detoxification. However, the most relevant indicator for prognosis was coma duration before the start of dialysis. Therefore, major efforts should be made to refer patients quickly to highly specialized centers.</description><subject>Amino acids</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>Coma</subject><subject>Coma - etiology</subject><subject>Coma - physiopathology</subject><subject>Emergency and intensive care: renal failure. Dialysis management</subject><subject>Glutamine - blood</subject><subject>Hemodialysis</subject><subject>Humans</subject><subject>Hyperammonemia - blood</subject><subject>Hyperammonemia - complications</subject><subject>Hyperammonemia - mortality</subject><subject>Hyperammonemia - therapy</subject><subject>Infant, Newborn</subject><subject>Intensive care medicine</subject><subject>Medical prognosis</subject><subject>Medical sciences</subject><subject>Patients</subject><subject>Peritoneal dialysis</subject><subject>Plasma</subject><subject>Prognosis</subject><subject>Proteins</subject><subject>Quaternary Ammonium Compounds - blood</subject><subject>Renal Dialysis - methods</subject><subject>Time Factors</subject><subject>Venous access</subject><issn>0931-041X</issn><issn>1432-198X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2001</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpd0M1LwzAYBvAgipvTo1cpgt6qbz7aNN5kzA8YeFGYp5KkqWa0zUxacP-9GSuInhLCLy_P-yB0juEGA_DbAMByDrs7kAM0xYySFItidYimIChOgeHVBJ2EsAaAIivyYzTBOC-yTMAUvS--ey-18xvnjWySyspmG2xIbJd0xnWyj4-f243xsm1dZ1ork7ukdZVsbG9NSGRXJRvvPjoXeqvjt8pq2TsfTtFRLZtgzsZzht4eFq_zp3T58vg8v1-mmrK8Twtlak5BVErFNTJSCWUo6AKUYkJrXrPckIoCyZgygjDguYJaU4GNBpUbOkPX-7kxxddgQl-2NmjTNDLmH0LJCYk4ExFe_oNrN_guZitJNBnLCxpRukfauxC8qcuNt6302xJDuSu5_FN49Bfj0EG1pvrVY8MRXI1ABi2b2stO2_DrGAaOOaU_hsGI2A</recordid><startdate>20011101</startdate><enddate>20011101</enddate><creator>PICCA, Stefano</creator><creator>DIONISI-VICI, Carlo</creator><creator>ABENI, Damiano</creator><creator>PASTORE, Anna</creator><creator>RIZZO, Cristiano</creator><creator>ORZALESI, Marcello</creator><creator>SABETTA, Gaetano</creator><creator>RIZZONI, Gianfranco</creator><creator>BARTULI, Andrea</creator><general>Springer</general><general>Springer Nature B.V</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20011101</creationdate><title>Extracorporeal dialysis in neonatal hyperammonemia : modalities and prognostic indicators</title><author>PICCA, Stefano ; DIONISI-VICI, Carlo ; ABENI, Damiano ; PASTORE, Anna ; RIZZO, Cristiano ; ORZALESI, Marcello ; SABETTA, Gaetano ; RIZZONI, Gianfranco ; BARTULI, Andrea</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c346t-8bef7309dbb67052d9be30c80bb49cc7f46e2d30254be924076b0fc391ec0b6e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2001</creationdate><topic>Amino acids</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>Coma</topic><topic>Coma - etiology</topic><topic>Coma - physiopathology</topic><topic>Emergency and intensive care: renal failure. Dialysis management</topic><topic>Glutamine - blood</topic><topic>Hemodialysis</topic><topic>Humans</topic><topic>Hyperammonemia - blood</topic><topic>Hyperammonemia - complications</topic><topic>Hyperammonemia - mortality</topic><topic>Hyperammonemia - therapy</topic><topic>Infant, Newborn</topic><topic>Intensive care medicine</topic><topic>Medical prognosis</topic><topic>Medical sciences</topic><topic>Patients</topic><topic>Peritoneal dialysis</topic><topic>Plasma</topic><topic>Prognosis</topic><topic>Proteins</topic><topic>Quaternary Ammonium Compounds - blood</topic><topic>Renal Dialysis - methods</topic><topic>Time Factors</topic><topic>Venous access</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>PICCA, Stefano</creatorcontrib><creatorcontrib>DIONISI-VICI, Carlo</creatorcontrib><creatorcontrib>ABENI, Damiano</creatorcontrib><creatorcontrib>PASTORE, Anna</creatorcontrib><creatorcontrib>RIZZO, Cristiano</creatorcontrib><creatorcontrib>ORZALESI, Marcello</creatorcontrib><creatorcontrib>SABETTA, Gaetano</creatorcontrib><creatorcontrib>RIZZONI, Gianfranco</creatorcontrib><creatorcontrib>BARTULI, Andrea</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Pediatric nephrology (Berlin, West)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>PICCA, Stefano</au><au>DIONISI-VICI, Carlo</au><au>ABENI, Damiano</au><au>PASTORE, Anna</au><au>RIZZO, Cristiano</au><au>ORZALESI, Marcello</au><au>SABETTA, Gaetano</au><au>RIZZONI, Gianfranco</au><au>BARTULI, Andrea</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Extracorporeal dialysis in neonatal hyperammonemia : modalities and prognostic indicators</atitle><jtitle>Pediatric nephrology (Berlin, West)</jtitle><addtitle>Pediatr Nephrol</addtitle><date>2001-11-01</date><risdate>2001</risdate><volume>16</volume><issue>11</issue><spage>862</spage><epage>867</epage><pages>862-867</pages><issn>0931-041X</issn><eissn>1432-198X</eissn><coden>PENED3</coden><abstract>We investigated the prognostic indicators in ten hyperammonemic neonates: four treated by continuous arteriovenous hemodialysis (CAVHD), four with continuous venovenous hemodialysis (CVVHD), and two with hemodialysis (HD). Plasma ammonium levels decreased significantly within the first 24 h irrespective of dialysis modality (from 1419 to 114 micromol/l, median values; P<0.0001). CVVHD achieved the highest ammonium clearance. HD provided highest ammonium extraction but clearance was hampered by severe hemodynamic instability. Five patients had a good outcome (normal at follow-up of 9-59 months), five had poor outcome (four died and one has severe neurological damage). Total coma duration was shorter in patients who had a good outcome (47+/-11 vs 78+/-13 h; P=0.02). Remarkably, only coma duration before dialysis determined this difference (22.2+/-10.1 vs 48.8+/-11.2 h; P=0.02). In cases with good outcome, coma duration was <33 h, whereas the others exceeded this limit. The prognosis was not related to dialysis modality, rapidity in reducing ammonium levels or to the underlying metabolic defect. In conclusion, results showed CVVHD to be the optimal modality for extracorporeal ammonium detoxification. However, the most relevant indicator for prognosis was coma duration before the start of dialysis. Therefore, major efforts should be made to refer patients quickly to highly specialized centers.</abstract><cop>Heidelberg</cop><pub>Springer</pub><pmid>11685590</pmid><doi>10.1007/s004670100702</doi><tpages>6</tpages></addata></record> |
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| ispartof | Pediatric nephrology (Berlin, West), 2001-11, Vol.16 (11), p.862-867 |
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| subjects | Amino acids Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Coma Coma - etiology Coma - physiopathology Emergency and intensive care: renal failure. Dialysis management Glutamine - blood Hemodialysis Humans Hyperammonemia - blood Hyperammonemia - complications Hyperammonemia - mortality Hyperammonemia - therapy Infant, Newborn Intensive care medicine Medical prognosis Medical sciences Patients Peritoneal dialysis Plasma Prognosis Proteins Quaternary Ammonium Compounds - blood Renal Dialysis - methods Time Factors Venous access |
| title | Extracorporeal dialysis in neonatal hyperammonemia : modalities and prognostic indicators |
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