Neurological development in 21 children on peritoneal dialysis in infancy

• Published in: Pediatric nephrology (Berlin, West) Vol. 26; no. 10; pp. 1863 - 1871
• Main Authors: Laakkonen, Hanne, Lönnqvist, Tuula, Valanne, Leena, Karikoski, Jukka, Holmberg, Christer, Rönnholm, Kai
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2011; Springer; Springer Nature B.V
• Subjects: Age; Anthropometry; Apgar score; Birth Weight; Brain - anatomy & histology; Child development; Children; Comorbidity; Developmental Disabilities - epidemiology; Developmental Disabilities - etiology; Female; Follow-Up Studies; Gestational Age; Growth - physiology; Hearing - physiology; Hearing Tests; Hemodialysis; Hospitals; Humans; Infant; Infant, Newborn; Kidney Failure, Chronic - complications; Kidney Failure, Chronic - therapy; Kidneys; Magnetic Resonance Imaging; Male; Medicine & Public Health; Nephrology; Nervous System - growth & development; Nervous system diseases; Nervous System Diseases - epidemiology; Neurologic Examination; Neuropsychology; Original Article; Otolaryngology; Patients; Pediatrics; Peritoneal dialysis; Peritoneal Dialysis - adverse effects; Risk Factors; Tomography, X-Ray Computed; Urology; Finland; Alberta Infant Motor Scale; Hearing; Brain imaging; Motor development; Neurodevelopment; Neuropsychological testing; Children; Risk factors
• ISSN: 0931-041X; 1432-198X
• DOI: 10.1007/s00467-011-1893-y

Few studies have focused on the neurodevelopment of infants on peritoneal dialysis (PD). Infants are the most demanding patient group on PD and thus are vulnerable to neurological sequelae. We studied 21 patients <2 years of age (mean 0.59 years) at onset of PD. They were evaluated by a neurologist, otologist, physiotherapist, and occupational therapist during PD. Neuropsychological tests were collected from all patients at least 5 years old, and the brain images were reviewed. Eleven patients (52%) had a pre- or neonatal problem or comorbidity as risk factor for their development at onset of PD. All infants tolerated PD well. At the end of the study, 71% had some neurological abnormality, 29% a major impairment (all with predialysis risk factors), and 43%  a minor one. Brain infarcts were detected in four patients (19%) and other ischemic lesions in three (14%). Three patients (14%) developed hearing defect. Mortality rate was 5%. PD is a safe treatment modality for end-stage renal failure in infants. Some patients had risk factors for development, but their neurological problems did not progress during PD. Patients without risk factors tolerated PD well without major neurological sequelae.