A case of neonatal gastric rupture undergoing PMX-DHP

Abstract

 We report a case of neonatal septic shock due to gastric rupture treated with PMX-direct hemoperfusion (PMX-DHP). A healthy G2P1 mother delivered a 3,215g male neonate at 38 weeks gestation. He was admitted to our hospital because of frequent vomiting of bloody gastric juice, abdominal distension, and free air of abdominal cavity. He was in bad condition and revealed significant hyperammonemia and high endotoxin concentration. He underwent continuous hemodiafiltration (CHDF) leading to mild decrease of plasma ammonia level, but the low blood pressure was not improved. There was a significant increase in blood pressure immediately after initial of PMX-DHP and his clinical condition improved remarkably. No complication was observed with this therapy. At laparotomy, spontaneous gastric rupture was confirmed and repaired. The effectiveness of PMX-DHP in clinical experience was reported in adults, but few in neonatal cases. We consider PMX-DHP to be an effective therapeutic option for infants with severe sepsis.