Newborn babyTreating the tiniest patients can be tricky in a number of ways: they are so extremely fragile, they can’t say what hurts, and the standard practices and protocols for treating bigger patients are not often tested for use in infants and small children. Most of the equipment and medical devices used for older patients are too big for babies, too.

One such device is the kidney dialysis machine. “Only a small number of (babies) need this treatment, but it could be life-saving,” according to Dr. Heather Lambert. When a baby needs dialysis, a machine made for larger patients must be scaled down to fit. Kidney problems severe enough to require dialysis affect fewer than 2% of all babies, who need the machines to cleanse toxins from the blood while their kidneys are too weak to do the job themselves. Lambert, a pediatric kidney specialist who is also spokeswoman for the British Royal College of Paediatrics and Child Health, is part of a group of medical researchers developing newborn-size dialysis machines.

Doctors in Italy are already using a newborn-sized dialysis machine that has saved little lives in that country. A report of their first success was published in a recent issue of the British medical journal, The Lancet.

In the Italian city of Vicenza, Dr. Claudio Ronco and his colleagues are using a mini-dialysis machine designed for use with babies who weigh no more than 22 pounds. Their dialysis machine — the miniaturized Cardio-Renal Pediatric Dialysis Emergency Machine (CARPEDIEM) — was granted a license for use by European authorities last summer. Within weeks, they were putting it to the test.

Ronco and his team were presented with a patient just 3 days old: a baby girl who weighed only 6.6 pounds. She was suffering from multiple organ failure and her medical outlook was so grim her parents had already made arrangements for her funeral.

Ronco’s team turned her whole life around.

Their tiny patient required about a month of dialysis treatments but, now, almost a year later, she is thriving. She still has mild kidney problems and vitamin D supplements are needed but she is growing at a rate normal for a baby of her age. Her parents recently brought her to visit Dr. Ronco, who describes the visit by saying, “The baby was crying like crazy because she was hungry, but she’s doing great.”

Since news of this first patient’s miraculous success began spreading, calls have come in from across Europe from doctors hoping to use the machine. Thus far, approximately ten more babies have used the Italian mini-dialysis machine.

Research and development of the newborn-sized dialysis machine were funded by a kidney advocacy group based in Italy. Dr. Ronco himself does not profit financially from the use of the machine, which would cost approximately $47,800 in US dollars.

In a published commentary to the Lancet study, Dr. Bethany Foster, associate professor of pediatrics at the Montreal Children’s Hospital, describes the mini-dialysis machine as “a pretty major advance for the smallest infants.” Of the first baby treated, she says, “I can’t imagine the baby they (treated) would have survived with the current technology.”

She cautions, however, that vigilance is required when considering dialysis for “very small babies because what you’re often doing amounts to heroic treatment. We need to be careful that we don’t just do things because we can.”

Source: Ronco, Claudio, MD, et al. “Continuous renal replacement therapy in neonates and small infants: development and first-in-human use of a miniaturised machine (CAREPDIEM).” The Lancet. Elsevier Limited. May 24, 2014. Web. Jun 2, 2014.

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