The efficacy and safety of continuous blood purification in neonates with septic shock and acute kidney injury: a two-center retrospective study

Purpose: To investigate the efficacy and safety of continuous blood purification (CBP) in neonates with septic shock and acute kidney injury (AKI). Methods A retrospective study was conducted in two tertiary care children's hospitals between January 2015 and May 2022. Results In this study, 26 neonates with septic shock and AKI were included with a mortality of 50%. Fourteen neonates (53.8%) received continuous veno-venous hemodiafiltration, while 12 (46.2%) received continuous veno-venous hemofiltration. Compared with the indexes before CBP, urine output increased 12h after CBP initiation ( P  = 0.003), and serum creatinine decreased ( P  = 0.019). After 24h of CBP, blood urea nitrogen had decreased ( P  = 0.006), and mean arterial pressure had increased ( P  = 0.007). At the end of CBP, vasoactive inotropic score and blood lactate were decreased ( P  = 0.035 and 0.038), and PH was increased ( P  = 0.015). The most common complication of CBP was thrombocytopenia, and univariate analysis identified no risk factors for CBP-related death. Conclusion CBP can efficiently maintain hemodynamic stability, improve renal function, and has good safety in neonates with septic shock and AKI. However, the mortality remains high, and whether CBP improves the prognosis of neonates with septic shock and AKI remains unclear.