Predicting Which Newborns Will Benefit from Early Peritoneal Dialysis following Cardiac Surgery: A Quest for Precision Medicine with Comparative Outcomes

Background: This retrospective single center study was conducted to investigate the accuracy of a clinical strategy in predicting newborns who will benefit from early peritoneal dialysis (PD) following cardiac surgery (post-op). Comparative outcomes are reported. Methods: There were forty-nine newborns. PD catheters were placed for all in the operating room (OR) following cardiopulmonary bypass (CPB). Those with longer CPB times, post-op oligo-anuria and worsening fluid overload were selected for early PD start (PD +). All PD + were started within the first post-op 24 hours. The primary outcomes were 5% fluid overload at post-op 48 hours and severe AKI at post-op day 5. Results: Twenty-nine subjects were started on early PD (PD +) and twenty used the PD catheter as abdominal drain (PD -). Baseline demographic data were indifferent. Both groups were oliguric during post-op first 8 hours (p= 0.906). The Early PD (+) group produced significantly less urine output during post-op day 1 (0.98 vs 3.02 ml/kg/hour; p= 0.001). At post-op 48 hours, early PD (+) group had similar prevalence of 5% fluid overload as early PD (-) group, (p= 0.427). Severe AKI incidence at post-op day 5 was low and similar between the groups (17.3% vs 5.0%; p=0.204). Conclusion: Persisting oliguria during post-op 24 hours may successfully identify those who will benefit from early PD. The first post-op 8 hours was indiscriminative for this decision. Placing the PD catheter in the OR may be an advantage. Early PD start may ameliorate the disadvantage for the designated group.