title: Short-term survival of hyperammonemic neonates treated with dialysis.
abstract: BACKGROUND
  In severe neonatal hyperammonemia, extracorporeal dialysis (ECD) provides higher ammonium clearance than peritoneal dialysis (PD). However, there are limited outcome data in relation to dialysis modality.
  
  
  METHODS
  Data from infants with hyperammonemia secondary to inborn errors of metabolism (IEM) treated with dialysis were collected in six Italian centers and retrospectively analyzed.
  
  
  RESULTS
  Forty-five neonates born between 1990 and 2011 were enrolled in the study. Of these, 23 were treated with PD and 22 with ECD (14 with continuous venovenous hemodialysis [CVVHD], 5 with continuous arteriovenous hemodialysis [CAVHD], 3 with hemodialysis [HD]). Patients treated with PD experienced a shorter duration of predialysis coma, while those treated with HD had a shorter ammonium decay time compared with all the other patients (p < 0.05). No difference in ammonium reduction rate was observed between patients treated with PD, CAVHD or CVVHD. Carbamoyl phosphate synthetase deficiency (CPS) was significantly associated with increased risk of death (OR: 9.37 [1.52-57.6], p = 0.016). Predialysis ammonium levels were significantly associated with a composite end-point of death or neurological sequelae (adjusted OR: 1.13 [1.02-1.27] per 100 μmol/l, p = 0.026). No association was found between outcome and dialysis modality.
  
  
  CONCLUSIONS
  In this study, a delayed ECD treatment was not superior to PD in improving the short-term outcome of neonates with hyperammonemia secondary to IEM.
authors.affiliation: Nephrology and Dialysis Unit, Department of Nephrology-Urology, "Bambino Gesù" Children's Hospital-IRCCS, Rome, Italy, stefano.picca@opbg.net.
authors.forename: Stefano
authors.initials: S
authors.lastname: Picca
authors.forename: Carlo
authors.initials: C
authors.lastname: Dionisi-Vici
authors.forename: Andrea
authors.initials: A
authors.lastname: Bartuli
authors.forename: Tommaso
authors.initials: T
authors.lastname: De Palo
authors.forename: Francesco
authors.initials: F
authors.lastname: Papadia
authors.forename: Giovanni
authors.initials: G
authors.lastname: Montini
authors.forename: Marco
authors.initials: M
authors.lastname: Materassi
authors.forename: Maria Alice
authors.initials: MA
authors.lastname: Donati
authors.forename: Enrico
authors.initials: E
authors.lastname: Verrina
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Schiaffino
authors.forename: Carmine
authors.initials: C
authors.lastname: Pecoraro
authors.forename: Emilia
authors.initials: E
authors.lastname: Iaccarino
authors.forename: Enrico
authors.initials: E
authors.lastname: Vidal
authors.forename: Alberto
authors.initials: A
authors.lastname: Burlina
authors.forename: Francesco
authors.initials: F
authors.lastname: Emma
mesh_terms: D005260:Female; D006801:Humans; D022124:Hyperammonemia / Q000209:etiology / Q000628:therapy*; D007231:Infant, Newborn; D008297:Male; D008661:Metabolism, Inborn Errors / Q000150:complications / Q000628:therapy; D010530:Peritoneal Dialysis / Q000379:methods; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome