{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T17:39:41Z","timestamp":1787161181254,"version":"build-2736575974"},"reference-count":10,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,9,1]]},"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.1542\/peds.2022-056570","type":"journal-article","created":{"date-parts":[[2022,8,9]],"date-time":"2022-08-09T23:04:27Z","timestamp":1660086267000},"source":"Crossref","is-referenced-by-count":14,"title":["Kidney Replacement Therapy in Low Birth Weight Preterm Newborns"],"prefix":"10.1542","volume":"150","author":[{"given":"Scott M.","family":"Sutherland","sequence":"first","affiliation":[{"name":"aDepartment of Pediatrics, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexis S.","family":"Davis","sequence":"additional","affiliation":[{"name":"bDepartment of Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Powell","sequence":"additional","affiliation":[{"name":"cNeonatal Intensive Care Unit, Lucile Packard Children\u2019s Hospital, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Tanaka","sequence":"additional","affiliation":[{"name":"dPediatric Dialysis Unit, Lucile Packard Children\u2019s Hospital, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mayna","family":"Woo","sequence":"additional","affiliation":[{"name":"dPediatric Dialysis Unit, Lucile Packard Children\u2019s Hospital, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shellie","family":"Josephs","sequence":"additional","affiliation":[{"name":"eDepartment of Radiology, Division of Interventional Radiology, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia J.","family":"Wong","sequence":"additional","affiliation":[{"name":"aDepartment of Pediatrics, Division of Nephrology, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2022,8,10]]},"reference":[{"key":"2023110816302389100_B1","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jpeds.2021.03.006","article-title":"An immature science: intensive care for infants born at \u226423 weeks of gestation","volume":"233","author":"Rysavy","year":"2021","journal-title":"J Pediatr"},{"issue":"11","key":"2023110816302389100_B2","doi-asserted-by":"crossref","first-page":"3607","DOI":"10.1007\/s00467-021-04977-1","article-title":"Neonatal acute kidney injury: a case-based approach","volume":"36","author":"Starr","year":"2021","journal-title":"Pediatr 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