Rapid resolution of hyperammonemia in neonates using extracorporeal membrane oxygenation as a platform to drive hemodialysis.

Robinson JR, Conroy PC, Hardison D, Hamid R, Grubb PH, Pietsch JB, Lovvorn HN
J Perinatol. 2018 38 (6): 665-671

PMID: 29467521 · PMCID: PMC6030490 · DOI:10.1038/s41372-018-0084-0

OBJECTIVE - We aimed to clarify the impact of extracorporeal membrane oxygenation (ECMO) as a platform to drive hemodialysis (HD) for ammonia clearance on outcomes of neonates with severe hyperammonemia.

STUDY DESIGN - All neonates treated for hyperammonemia at a single children's hospital between 1992 and 2016 were identified. Patient characteristics and outcomes were compared between those receiving medical management or ECMO/HD.

RESULT - Twenty-five neonates were treated for hyperammonemia, of which 13 (52%) received ECMO/HD. Peak ammonia levels among neonates treated with ECMO/HD were significantly higher than those medically managed (1041 [IQR 902-1581] μmol/L versus 212 [IQR 110-410] μmol/L; p = 0.009). Serum ammonia levels in the ECMO/HD cohort declined to the median of medically managed within 4.5 (IQR 2.9-7.0) hours and normalized within 7.3 (IQR 3.6-13.5) hours. All neonates survived ECMO/HD, and nine (69.2%) survived to discharge.

CONCLUSION - ECMO/HD is an effective adjunct to rapidly clear severe hyperammonemia in newborns, reducing potential neurodevelopmental morbidity.

MeSH Terms (19)

Ammonia Cohort Studies Extracorporeal Membrane Oxygenation Female Hospitals, Pediatric Humans Hyperammonemia Infant, Newborn Logistic Models Male Peritoneal Dialysis Prognosis Referral and Consultation Renal Dialysis Retrospective Studies Risk Assessment Severity of Illness Index Survival Rate Treatment Outcome

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