Analysis in clinical application of continuous renal replacement therapy for 31 neonates

Objective To investigate the risk factors for filter coagulation during continuous renal replacement therapy (CRRT) in neonates.

Methods The clinical data of 31 full-term neonates who underwent CRRT in the neonatal intensive care unit of Hunan Children's Hospital from March 2020 to February 2025 were retrospectively analyzed. The filter survival rate was analyzed by the Kaplan-Meier survival analysis, and the risk factors for filter coagulation were analyzed by the Cox proportional hazards regression model.

Results A total of 18 neonates (58.1%, survival group) survived, while 13 cases (41.9%, non-survival group) died. The main indications for initiating CRRT were septic shock (29.0%) and genetic metabolic crisis (25.8%). Prior to CRRT, 96.8% of the neonates required mechanical ventilation, and 93.5% needed vasoactive drugs.The Neonatal Critical Illness Score (NCIS) was 70.0(66.0, 72.0) points.The NCIS, hemoglobin levels, platelet counts, and albumin levels in the survival group were all significantly higher than those in the non-survival group (all P < 0.05). The filter lifespan was 35.0(25.0, 37.0) hours. The complications of CRRT included hypotension (25.8%), catheter-related thrombosis (6.5%), and bleeding events (6.5%); no cases of hypothermia or catheter-related infection were observed. Univariate and multivariate Cox regression analyses revealed that the anticoagulation method, red blood cell transfusion during CRRT, and a catheter/vein diameter ratio>0.33 were all independent influencing factors for filter coagulation (P < 0.05). The absence of anticoagulation (HR=7.276, 95%CI, 2.246 to 23.572, P < 0.001), red blood cell transfusion during CRRT (HR=3.176, 95%CI, 1.048 to 9.622, P=0.041), and a catheter/vein diameter ratio >0.33 (HR=3.486, 95%CI, 1.360 to 8.933, P=0.009) increased the risk of filter coagulation.

Conclusion CRRT is feasible in full-term critically ill neonates.Reasonable anticoagulation, prudent transfusion management, and the selection of catheters that match the vascular diameter are crucial for optimizing filter lifespan.