American Journal of Pediatrics

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Application of Hemoadsorption in Neonatal and Pediatric Hyperinflammatory States: A Case Series

Received: 20 February 2019    Accepted: 09 April 2019    Published: 06 May 2019
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Abstract

Objective: Extracorporeal blood purification therapies are increasingly applied in the field of intensive care medicine. Compared to filtration-based methods mainly used for renal replacement therapy, newest adsorptive approaches have shown to specifically target the inflammatory cascade by the effective removal of relevant mediators. In the neonatal and pediatric setting however, the application of these methods brings with it various challenges but also profound technical difficulties. Recently, a promising extracorporeal device for cytokine adsorption (CytoSorb) was introduced. However, data for its application in critically ill pediatric patients remains sparse. Design: Single center retrospective case study; Setting: Tertiary neonatal and pediatric general intensive care unit; Patients: The study comprised 10 critically ill pediatric patients; Interventions: We describe the use of CytoSorb in combination with standard therapy, continuous renal replacement therapy (CRRT) and plasmapheresis in ten severely ill pediatric patients with multiple organ failures of various etiologies; Measurements: The aim was to assess the effects on the inflammatory status, hemodynamics, and clinically relevant outcome parameters as well as the feasibility and safety of CytoSorb application in pediatrics; Main Results: We observed a marked decrease in inflammatory mediators, a reduction in catecholamine dosages and an improvement in organ functions, which was particularly pronounced in patients who survived. An early onset of treatment (at best within 24-48 hours after diagnosis of sepsis) seemed to be beneficial for eventual survival. Conclusions: The present case series is the first documentation of a set of pediatric/neonatal patients in which a combined therapeutic approach of hemoadsorption and renal replacement therapy showed promising results with regard to hemodynamic stabilization, control of the inflammatory response, improvement in organ functions as well as safety and feasibility. Further prospective randomized controlled studies in the pediatric field are necessary to elucidate the full potential of hemoadsorption in this set of patients.

DOI 10.11648/j.ajp.20190502.11
Published in American Journal of Pediatrics (Volume 5, Issue 2, June 2019)
Page(s) 34-42
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Multiple Organ Failure, Pediatrics, Hyperinflammation, Plasmapheresis, Hemoadsorption, Cytosorb

References
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[2] Träger K, Fritzler D, Fischer G, et al: Treatment of post-cardiopulmonary bypass SIRS by hemoadsorption: a case series. Int J Artif Organs 2016;39:141-6.
[3] Datzmann T, Träger K: Extracorporeal membrane oxygenation and cytokine adsorption. J Thorac Dis 2018;10:S653-S660.
[4] Honore PM, Jacobs R, Joannes-Boyau O, et al: Newly designed CRRT membranes for sepsis and SIRS-- a pragmatic approach for bedside intensivists summarizing the more recent advances: a systematic structured review. ASAIO J 2013;59:99-106.
[5] Eyre M, Hacohen Y, Barton C, et al: Therapeutic plasma exchange in paediatric neurology: a critical review and proposed treatment algorithm. Dev Med Child Neurol 2018;60:765-779.
[6] Milella L: Neonatal and Pediatric General and Cardiac Anaesthesia and ICU: wath‟s new in 2017/2018? -Bari Pediatric Hospital Experience-Italy." Journal of Pediatrics and Neonatal Care 2018;8:00309.
[7] Bonavia A, Groff A, Karamchandani K, et al: Clinical Utility of Extracorporeal Cytokine Hemoadsorption Therapy: A Literature Review. Blood Purif 2018;46:337-349.
[8] Milella L, Ficarella M: First Application of CVVHDF, Plasmapheresis and “Cytosorb a Bsorber” to Solve a Pediatric Haemophagocitic Histyocitosis Case. Res Pediatr Neonatol 2017;1: RPN.000510.
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[10] Gruda MC, Ruggeberg KG, O'Sullivan P, et al: Broad adsorption of sepsis-related PAMP and DAMP molecules, mycotoxins, and cytokines from whole blood using CytoSorb® sorbent porous polymer beads. PLoS One 2018;13:e0191676.
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[17] Pinsky MR, Vincent JL, Deviere J, et al: Serum cytokine levels in human septic shock. Relation to multiple-system organ failure and mortality. Chest 1993;103:565-75.
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Author Information
  • Department of General Pediatric and Neonatal Anesthesia and ICU-Neonatal and Pediatric Cardiac Anesthesia and ICU, Pediatric Hospital Giovanni XXIII, Bari, Italy

  • Department of General Pediatric and Neonatal Anesthesia and ICU-Neonatal and Pediatric Cardiac Anesthesia and ICU, Pediatric Hospital Giovanni XXIII, Bari, Italy

  • Department of General Pediatric and Neonatal Anesthesia and ICU-Neonatal and Pediatric Cardiac Anesthesia and ICU, Pediatric Hospital Giovanni XXIII, Bari, Italy

  • Department of General Pediatric and Neonatal Anesthesia and ICU-Neonatal and Pediatric Cardiac Anesthesia and ICU, Pediatric Hospital Giovanni XXIII, Bari, Italy

  • Department of General Pediatric and Neonatal Anesthesia and ICU-Neonatal and Pediatric Cardiac Anesthesia and ICU, Pediatric Hospital Giovanni XXIII, Bari, Italy

  • Department of General Pediatric and Neonatal Anesthesia and ICU-Neonatal and Pediatric Cardiac Anesthesia and ICU, Pediatric Hospital Giovanni XXIII, Bari, Italy

  • Department of General Pediatric and Neonatal Anesthesia and ICU-Neonatal and Pediatric Cardiac Anesthesia and ICU, Pediatric Hospital Giovanni XXIII, Bari, Italy

  • Department of General Pediatric and Neonatal Anesthesia and ICU-Neonatal and Pediatric Cardiac Anesthesia and ICU, Pediatric Hospital Giovanni XXIII, Bari, Italy

  • Department of Pediatric Nephrology and Dialysis, Pediatric Hospital Giovanni XXIII, Bari, Italy

  • Department of Pediatric Nephrology and Dialysis, Pediatric Hospital Giovanni XXIII, Bari, Italy

  • Department of Pediatric Nephrology and Dialysis, Pediatric Hospital Giovanni XXIII, Bari, Italy

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  • APA Style

    Leonardo Milella, Maria Teresa Ficarella, Gerolmina Calabrese, Michele Sisto, Rita Luana Grieco, et al. (2019). Application of Hemoadsorption in Neonatal and Pediatric Hyperinflammatory States: A Case Series. American Journal of Pediatrics, 5(2), 34-42. https://doi.org/10.11648/j.ajp.20190502.11

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    ACS Style

    Leonardo Milella; Maria Teresa Ficarella; Gerolmina Calabrese; Michele Sisto; Rita Luana Grieco, et al. Application of Hemoadsorption in Neonatal and Pediatric Hyperinflammatory States: A Case Series. Am. J. Pediatr. 2019, 5(2), 34-42. doi: 10.11648/j.ajp.20190502.11

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    AMA Style

    Leonardo Milella, Maria Teresa Ficarella, Gerolmina Calabrese, Michele Sisto, Rita Luana Grieco, et al. Application of Hemoadsorption in Neonatal and Pediatric Hyperinflammatory States: A Case Series. Am J Pediatr. 2019;5(2):34-42. doi: 10.11648/j.ajp.20190502.11

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  • @article{10.11648/j.ajp.20190502.11,
      author = {Leonardo Milella and Maria Teresa Ficarella and Gerolmina Calabrese and Michele Sisto and Rita Luana Grieco and Paola Moliterni and Pasquale Raimondo and Fabiana Cito and Vito Bellino and Antonio Ranieri and Mario Giordano},
      title = {Application of Hemoadsorption in Neonatal and Pediatric Hyperinflammatory States: A Case Series},
      journal = {American Journal of Pediatrics},
      volume = {5},
      number = {2},
      pages = {34-42},
      doi = {10.11648/j.ajp.20190502.11},
      url = {https://doi.org/10.11648/j.ajp.20190502.11},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajp.20190502.11},
      abstract = {Objective: Extracorporeal blood purification therapies are increasingly applied in the field of intensive care medicine. Compared to filtration-based methods mainly used for renal replacement therapy, newest adsorptive approaches have shown to specifically target the inflammatory cascade by the effective removal of relevant mediators. In the neonatal and pediatric setting however, the application of these methods brings with it various challenges but also profound technical difficulties. Recently, a promising extracorporeal device for cytokine adsorption (CytoSorb) was introduced. However, data for its application in critically ill pediatric patients remains sparse. Design: Single center retrospective case study; Setting: Tertiary neonatal and pediatric general intensive care unit; Patients: The study comprised 10 critically ill pediatric patients; Interventions: We describe the use of CytoSorb in combination with standard therapy, continuous renal replacement therapy (CRRT) and plasmapheresis in ten severely ill pediatric patients with multiple organ failures of various etiologies; Measurements: The aim was to assess the effects on the inflammatory status, hemodynamics, and clinically relevant outcome parameters as well as the feasibility and safety of CytoSorb application in pediatrics; Main Results: We observed a marked decrease in inflammatory mediators, a reduction in catecholamine dosages and an improvement in organ functions, which was particularly pronounced in patients who survived. An early onset of treatment (at best within 24-48 hours after diagnosis of sepsis) seemed to be beneficial for eventual survival. Conclusions: The present case series is the first documentation of a set of pediatric/neonatal patients in which a combined therapeutic approach of hemoadsorption and renal replacement therapy showed promising results with regard to hemodynamic stabilization, control of the inflammatory response, improvement in organ functions as well as safety and feasibility. Further prospective randomized controlled studies in the pediatric field are necessary to elucidate the full potential of hemoadsorption in this set of patients.},
     year = {2019}
    }
    

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  • TY  - JOUR
    T1  - Application of Hemoadsorption in Neonatal and Pediatric Hyperinflammatory States: A Case Series
    AU  - Leonardo Milella
    AU  - Maria Teresa Ficarella
    AU  - Gerolmina Calabrese
    AU  - Michele Sisto
    AU  - Rita Luana Grieco
    AU  - Paola Moliterni
    AU  - Pasquale Raimondo
    AU  - Fabiana Cito
    AU  - Vito Bellino
    AU  - Antonio Ranieri
    AU  - Mario Giordano
    Y1  - 2019/05/06
    PY  - 2019
    N1  - https://doi.org/10.11648/j.ajp.20190502.11
    DO  - 10.11648/j.ajp.20190502.11
    T2  - American Journal of Pediatrics
    JF  - American Journal of Pediatrics
    JO  - American Journal of Pediatrics
    SP  - 34
    EP  - 42
    PB  - Science Publishing Group
    SN  - 2472-0909
    UR  - https://doi.org/10.11648/j.ajp.20190502.11
    AB  - Objective: Extracorporeal blood purification therapies are increasingly applied in the field of intensive care medicine. Compared to filtration-based methods mainly used for renal replacement therapy, newest adsorptive approaches have shown to specifically target the inflammatory cascade by the effective removal of relevant mediators. In the neonatal and pediatric setting however, the application of these methods brings with it various challenges but also profound technical difficulties. Recently, a promising extracorporeal device for cytokine adsorption (CytoSorb) was introduced. However, data for its application in critically ill pediatric patients remains sparse. Design: Single center retrospective case study; Setting: Tertiary neonatal and pediatric general intensive care unit; Patients: The study comprised 10 critically ill pediatric patients; Interventions: We describe the use of CytoSorb in combination with standard therapy, continuous renal replacement therapy (CRRT) and plasmapheresis in ten severely ill pediatric patients with multiple organ failures of various etiologies; Measurements: The aim was to assess the effects on the inflammatory status, hemodynamics, and clinically relevant outcome parameters as well as the feasibility and safety of CytoSorb application in pediatrics; Main Results: We observed a marked decrease in inflammatory mediators, a reduction in catecholamine dosages and an improvement in organ functions, which was particularly pronounced in patients who survived. An early onset of treatment (at best within 24-48 hours after diagnosis of sepsis) seemed to be beneficial for eventual survival. Conclusions: The present case series is the first documentation of a set of pediatric/neonatal patients in which a combined therapeutic approach of hemoadsorption and renal replacement therapy showed promising results with regard to hemodynamic stabilization, control of the inflammatory response, improvement in organ functions as well as safety and feasibility. Further prospective randomized controlled studies in the pediatric field are necessary to elucidate the full potential of hemoadsorption in this set of patients.
    VL  - 5
    IS  - 2
    ER  - 

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