Managing newborns with kidney failure is a complex undertaking; even under ideal circumstances, dialysis is technically challenging and available therapies are designed for adults. These issues are exacerbated in smaller newborns, and intervention has traditionally not been offered in those below a certain weight threshold. Ethical concerns abound and patients deemed too small for dialysis are typically transitioned to comfort or palliative care. However, many of these neonates are otherwise healthy and would be considered survivable if kidney replacement therapy were available. To challenge the existing paradigm, we present 7 preterm, low birth weight neonates with end-stage kidney disease who were successfully managed using an innovative approach to kidney replacement therapy. These newborns had a median gestational age of 32 weeks (interquartile range [IQR], 32-35) and a median birth weight of 1.58 kg (IQR, 1.41-2.01). Kidney replacement therapy was initiated at a median age of 16 days (IQR, 1.5-40) and a weight of 1.85 kg (IQR, 1.57-2.1). Five of the 7 newborns (71%) survived to hospital discharge. Kidney replacement therapy was provided using 3F and 4F single lumen catheters and a modified ultrafiltration device. Patients experienced excellent metabolic control, and fluid homeostasis was achieved in the first week of life. Furthermore, survivors experienced physiologic weight gain and linear growth throughout their hospitalization. These findings, although preliminary, are encouraging for our smallest patients with kidney failure and suggest that survivability thresholds should be reexamined. At a minimum, neonatologists should be aware that novel approaches exist and may be considered for these challenging patients.

中文翻译：

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低出生体重早产儿的肾脏替代疗法。

管理患有肾衰竭的新生儿是一项复杂的工作；即使在理想情况下，透析在技术上也具有挑战性，并且现有的疗法是为成人设计的。这些问题在较小的新生儿中更为严重，并且传统上不会对低于某个体重阈值的新生儿进行干预。伦理问题比比皆是，被认为太小而无法进行透析的患者通常会过渡到舒适或姑息治疗。然而，这些新生儿中的许多人在其他方面都很健康，如果可以进行肾脏替代治疗，他们将被认为可以存活。为了挑战现有的范式，我们介绍了 7 名患有终末期肾病的早产儿、低出生体重新生儿，他们使用创新的肾脏替代疗法成功地进行了治疗。这些新生儿的中位胎龄为 32 周（四分位距 [IQR]，32-35），中位出生体重为 1.58 公斤（IQR，1.41-2.01）。肾脏替代治疗在中位年龄 16 天（IQR，1.5-40）和体重 1.85 公斤（IQR，1.57-2.1）时开始。7 名新生儿中有 5 名 (71%) 存活至出院。使用 3F 和 4F 单腔导管和改进的超滤装置提供肾脏替代治疗。患者经历了良好的代谢控制，并且在生命的第一周内实现了液体稳态。此外，幸存者在住院期间经历了生理性体重增加和线性增长。这些发现虽然是初步的，但对于我们最小的肾衰竭患者来说是令人鼓舞的，并表明应该重新检查生存阈值。最低限度，