ECMO as a Platform for Rapid Ammonia Removal in a Neonate with Multienzyme Urea Cycle Disorder.

Journal: The Journal Of Extra-Corporeal Technology
Treatment Used: Neonatal Extracorporeal Membrane Oxygenation (ECMO)
Number of Patients: 1
Published:
MediFind Summary

Summary: In this case study, researchers evaluated the outcomes of using neonatal extracorporeal membrane oxygenation (ECMO) to treat the dangerously high level of ammonia in the blood of a newborn with multi-enzyme urea cycle disorder.

Conclusion: For this newborn, use of neonatal extracorporeal membrane oxygenation successfully removed the high levels of ammonia in her blood that was due to multi-enzyme urea cycle disorder.

Abstract

Since the initial deployment of neonatal extracorporeal membrane oxygenation (ECMO) for respiratory failure, the use of ECMO in this population has diversified. We present a term female infant with carbamoyl phosphate synthetase 1 and partial N-acetylglutamate synthase deficiencies who developed severe hyperammonemia refractory to medical management requiring venoarterial ECMO-driven continuous veno-venous hemodiafiltration for ammonia detoxification. This case report illustrates a subpopulation where neonatal ECMO may improve survival and neurodevelopmental outcomes. To our knowledge, this is the first reported case of a urea cycle defect arising from two proximal enzyme deficiencies. Also, this is one of the few reported patients with UCD associated with peak ammonia levels >2,000 μmol/L who survived to hospital discharge after the successful use of ECMO for ammonia reduction. This case will add to the existing scant literature supporting the use of ECMO as a platform for rapid removal of serum ammonia.

Authors
Kelechi Ikeri, Vilmaris Cardona, Abena Hagan Brown, Megan Young, Michael Schneider, Ogechukwu Menkiti

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