2019 Volume 10 Issue 2 Pages 135-138
In neonatal hyperammonemia, it is necessary to rapidly lower the blood ammonia level. Although acute blood purification therapy is an effective tool, it is difficult to ensure sufficient blood flow in neonates, and the optimal conditions are unknown. According to the principle of blood purification, in order to obtain sufficient clearance, it is necessary to secure a sufficient blood flow rate (Qb) and a dialysate flow rate (Qd) that is twice or more than the Qb. For two neonates who had hyperammonemia due to inborn errors of metabolism, we were able to perform continuous hemodialysis (CHD) safely with gradually increasing efficiency, while maintaining the ratio of Qb to Qd (Qb：Qd＝1：2). The efficiency in reducing the blood ammonia level was increased with a Qb of 3.57 mL/kg/min and Qd of 1200 mL/h (7.14 mL/kg/h) in case 1 and a Qb of 4.55 mL/kg/min and Qd of 1800 mL/h (9.09 mL/kg/min) in case 2. For neonatal hyperammonemia, a CHD that secures a Qb of at least 3.5 mL/kg/min or more and Qd that is double its Qb may be effective in lowering the blood ammonia level.
