Continuous renal replacement therapy for severe transient hyperammonemia in a preterm infant weighing 1120 g: A case report

Abstract

Transient hyperammonemia of the newborn is a rare form of hyperammonemia with an unclear, likely nongenetic etiology, primarily affecting larger preterm infants. However, lower birth weight and gestational age are associated with higher ammonia levels, increasing the risk of neurotoxicity and hepatotoxicity. Transient hyperammonemia of the newborn typically manifests as respiratory distress within the first 24 h post-birth, progressing to seizures and coma within 48 h. Continuous renal replacement therapy has demonstrated considerable efficacy in managing severe transient hyperammonemia of the newborn due to its high ammonia clearance rate; however, its application remains limited in very low birth weight preterm infants. Herein, we report the case of a male infant born at 28⁺² weeks gestation, weighing 1120 g, who developed transient hyperammonemia of the newborn 22 h post-birth. Despite initial pharmacotherapy and peritoneal dialysis, his ammonia levels continued to rise, necessitating continuous renal replacement therapy. After 42 h of continuous renal replacement therapy, his ammonia levels decreased significantly and he recovered fully, eventually being discharged in good health. This case highlights continuous renal replacement therapy as a viable, life-saving intervention for severe transient hyperammonemia of the newborn, even in very low birth weight preterm infants.

Keywords: Transient hyperammonemia; continuous renal replacement therapy; newborn; preterm infant; very low birth weight.

Figure 1.

Fluctuation in blood ammonia levels over hours.