title: Utility of peritoneal dialysis in neonates affected by inborn errors of metabolism.
abstract: OBJECTIVE
  Some inborn errors of metabolism induce metabolic encephalopathy through accumulation of neurotoxic metabolites. Rapid elimination of these metabolites by peritoneal or extracorporeal dialysis is crucial to prevent neuronal damage or death. In this retrospective study, we evaluated the outcomes of nine neonates with metabolic crisis treated with peritoneal dialysis.
  
  
  METHODS
  Six neonates with hyperammonemic coma (four with organic acidemias, two with urea cycle disorders) and three with leucine accumulation due to maple syrup urine disease (MSUD) were managed with peritoneal dialysis in conjunction with dietary and pharmacological therapy.
  
  
  RESULTS
  Three patients with organic acidemia survived. One of the patients was normal; others had moderate and severe neurological impairments. One neonate with organic acidemia and both neonates with urea cycle disorders died. Two of the three patients with MSUD survived without neurological impairment; the other had severe neurological damage and died at 9 months of age due to sepsis.
  
  
  CONCLUSIONS
  Theoretically, extracorporeal dialysis should be the first dialysis treatment of choice; however, this report demonstrates that peritoneal dialysis has a chance to prevent neurological damage in some patients. Therefore, in developing countries without extracorporeal dialysis opportunities, it can be still a life-saving procedure, if it is applied with skilled staff and standard procedures.
authors.affiliation: Division of Neonatology, Republic of Turkey Ministry of Health Ankara Children's Hematology and Oncology Research Hospital, Ankara, Turkey.
authors.forename: Leyla
authors.initials: L
authors.lastname: Bilgin
authors.forename: Sevim
authors.initials: S
authors.lastname: Unal
authors.forename: Mehmet
authors.initials: M
authors.lastname: Gunduz
authors.forename: Nermin
authors.initials: N
authors.lastname: Uncu
authors.forename: Tugrul
authors.initials: T
authors.lastname: Tiryaki
mesh_terms: D000592:Amino Acid Metabolism, Inborn Errors / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010530:Peritoneal Dialysis; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: inborn errors of metabolism; neonate; peritoneal dialysis