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Rapid resolution of hyperammonemia in neonates using extracorporeal membrane oxygenation as a platform to drive hemodialysis

Abstract

Objective

We aimed to clarify the impact of extracorporeal membrane oxygenation (ECMO) as a platform to drive hemodialysis (HD) for ammonia clearance on outcomes of neonates with severe hyperammonemia.

Study design

All neonates treated for hyperammonemia at a single children’s hospital between 1992 and 2016 were identified. Patient characteristics and outcomes were compared between those receiving medical management or ECMO/HD.

Result

Twenty-five neonates were treated for hyperammonemia, of which 13 (52%) received ECMO/HD. Peak ammonia levels among neonates treated with ECMO/HD were significantly higher than those medically managed (1041 [IQR 902–1581] μmol/L versus 212 [IQR 110–410] μmol/L; p = 0.009). Serum ammonia levels in the ECMO/HD cohort declined to the median of medically managed within 4.5 (IQR 2.9–7.0) hours and normalized within 7.3 (IQR 3.6–13.5) hours. All neonates survived ECMO/HD, and nine (69.2%) survived to discharge.

Conclusion

ECMO/HD is an effective adjunct to rapidly clear severe hyperammonemia in newborns, reducing potential neurodevelopmental morbidity.

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Acknowledgements

JR Robinson receives salary and tuition support from the National Institutes of Health National Library of Medicine (T15 LM007450).

Funding

Supported by the National Institutes of Health National Library of Medicine (T15 LM007450 to JRR).

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Correspondence to Jamie R. Robinson.

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The authors declare that they have no conflict of interest.

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Robinson, J.R., Conroy, P.C., Hardison, D. et al. Rapid resolution of hyperammonemia in neonates using extracorporeal membrane oxygenation as a platform to drive hemodialysis. J Perinatol 38, 665–671 (2018). https://doi.org/10.1038/s41372-018-0084-0

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