Inside Pediatrics Winter 2015

Novel Approach to Dialysis in Babies is Saving Lives

From his office on the fifth floor of the Lowder Building at Children’s of Alabama, David Askenazi, M.D., M.S.P.H., heads the international Neonatal Kidney Collaborative to more closely unite neonatologists and pediatric nephrologists in saving the lives of the tiniest babies who are battling acute kidney disease. To provide those infants with the best available comprehensive multidisciplinary clinical care, education and research, Askenazi established the Pediatric and Infant Center for Acute Nephrology (PICAN) at Children’s in 2013. His innovative approach to caring for babies who need renal support therapy is by using the Aquadex FlexFlow™, a machine specifically designed to remove salt and water in adults with heart failure that has a smaller filter and tubing size than other similar equipment. Askenazi and his team are the first in the nation to adapt the Aquadex for use in providing clearance of toxins, electrolyte balance and fluid removal in neonates. “Because Aquadex machines have much smaller blood filters and tubing than traditional dialysis machines, they allow us to effectively support these infants in a much safer way,” he said. In the past two years, Askenazi and his team have used the specialized equipment in treating more than 20 infants and small children. His approach has doubled the typical survival rate and prompted Seattle Children’s and Cincinnati Children’s Hospital Medical Center to follow his lead in adopting similar programs. “Prior to having this machine, when faced with a baby who needed acute dialysis, our choice was either to do nothing or to attempt to support the infant with a machine designed to provide Pediatric nephrologist David Askenazi, M.D., M.S.P.H., has successfully adapted the use of the Aquadex Flexflow to support critically ill infants who have acute kidney failure. The smaller size tubing and filter allow circuit initiation with less hemodynamics instability, avoiding the dagerous dramatic fluctuations in fluid volume encountered with the use of standard adult equipment.

Inside the Medicine

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