Inside Pediatrics Spring/Summer 2024

NEPHROLOGY + NEONATOLOGY

The nephrology team at Children’s used the Aquadex FlexFlow System to provide continuous venovenous hemofiltration for patients in the study.

valves, bilateral renal dysplasia and autosomal recessive polycystic kidney disease. Despite gestational age ranging from 35.6 to 37.1 weeks and birth weight from 2,740 grams to 3,140 grams, all five patients received KST by postnatal day seven. Additionally, they were all placed on ECMO “What we learned in this very small cohort is that these lungs can develop and grow if given a chance.” KARA SHORT, MSN, CRNP, CPNP-PC

within the first nine postnatal days due to severe respiratory distress after being unresponsive to conventional interventions.

Traditionally, extracorporeal membrane oxygenation (ECMO) was deemed unsuitable for this population due to perceived nonviability. In 2016, at the family’s request, a baby with severe congenital kidney failure and severe respiratory failure was placed on ECMO to be given a chance at life. The baby also required kidney support therapy (KST) to survive. After receiving a kidney transplant at age 2, the child now goes to school, plays sports, sings and dances. Since 2016, of the 31 neonates with congenital kidney failure who were admitted to the Children’s neonatal intensive care unit (NICU), five required ECMO support and KST in the first two weeks of life. In February 2024, Kara Short, MSN, CRNP, CPNP-PC, David Askenazi, M.D., MSPH, and others published a case report in Pediatrics , highlighting the complex treatment of the five babies and the journey to NICU discharge for the four survivors. This study challenges the previous norms and conventions that these babies had no chance at life. Congenital kidney failure poses unique challenges to neonates, affecting not only renal homeostasis but also respiratory integrity. Diagnoses among the five patients in the study included posterior urethral

An ECMO machine in use on a patient at Children’s of Alabama. Traditionally, ECMO has not been used on neonates with congenital kidney disease, but that’s changing thanks to a study done at Children’s of Alabama.

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Inside Pediatrics | Children’s of Alabama