ACUTE HEMODIALYSIS OF INFANTS WEIGHING LESS-THAN-5 KILOGRAMS

The records of 33 infants weighing 5 kg or less who received acute hem odialysis treatment at Children's Hospital between 1980 and 1991 were reviewed. Dialysis was initiated to treat hyperammonemia (8), primary renal or renovascular disease (7), and acute renal failure (18). The i nfants weighed 2.2 to 4.0 kg at birth and 27% were born prematurely. T he infants were 2 to 120 days of age (median 10 days) and weighed 2.2 to 5.0 kg (median 3.5 kg) at the initiation of hemodialysis. Hemodialy sis access was achieved via double-lumen 7 French catheters in 49% of the infants, the ECMO circuit in 24%, and the umbilical vessels in 27% . Thirty-three infants underwent a total of 216 hemodialysis treatment s. Only nine treatments were discontinued prematurely: six for intract able hypotension and three for technical problems. Fifty-two percent ( 17 of 33) of the infants survived through the end of the hemodialysis treatment course. The survival rates for the infants with hyperammonem ia (75%) and primary renal disease (71%) were better than those for in fants with acute renal failure (33%). The survivors did not differ fro m those who died with respect to birthweight, weight when hemodialysis was initiated, or the number of hemodialysis treatments administered. We conclude that infants weighing less than 5 kg can be treated succe ssfully with hemodialysis. Patient survival is related to underlying m edical problems, not to complications of hemodialysis.