Awaiting a transplant
The first 24 hours
Mateo is prenatally diagnosed by a fetal ultrasound with a rare and complicated condition called cloacal exstrophy (OEIS syndrome). This condition is confirmed upon birth, during his physical exam. Soon after admission to the NICU, AKI and renal failure is diagnosed and the inability to excrete urine leads to fluid overload (FO) despite maximal medical management. Dialysis with Carpediem™ cardio-renal pediatric dialysis emergency machine starts immediately to resolve his FO.
24 hours & after
A few days after Mateo is born, pediatric surgeons and his urologist prepare for bladder revision surgery to repair the omphalocele. The surgery involves closing the bladder halves and creating a colostomy for the elimination of stool.
Surgery is a major undertaking and Mateo’s internal systems are very vulnerable. His nurses are keeping a close watch on his continuous monitoring to ensure that everything is functioning properly post-op.
Mateo remains in the NICU while the neonatologist uses the INVOS™ regional oximetry system to track and confirm the gastrointestinal and urinary systems are properly recovering and functioning after the surgical repair. He will likely need a kidney transplant in the future. Until then, his kidney support therapies continue as he grows, eventually transitioning from pCRRT to peritoneal dialysis for his chronic care. Mateo remains on chronic peritoneal dialysis — until he is able to receive a transplant.
Fluid overload is an increased level of fluid in the body that can cause swelling, rapid weight gain, high blood pressure, and overwork the heart.
In Mateo’s case, FO is due to a bladder defect and renal failure and his neonatologist uses the Carpediem™ dialysis system to treat the FO. Post-operation, while Mateo remains in fragile condition, the Carpediem™ dialysis system provides pediatric continuous renal replacement therapy (pCRRT) for kidney dysfunction. He will continue on pCRRT with the Carpediem dialysis system until he is cleared for surgery to insert a peritoneal dialysis catheter for chronic care.
The first of its kind, the Carpediem™ dialysis system offers a miniaturized extracorporeal CRRT specifically designed for fragile, low weight pediatric patients weighing 2.5 to 10 kgs.
The Carpediem™ system is indicated for acute kidney injury or fluid overloaded patients requiring hemodialysis or hemofiltration therapy and weighing 2.5 - 10 kilograms. General contraindications for extracorporeal renal replacement therapies include, but are not limited to: hemodynamic instability, contraindication to suitable anticoagulation, and low platelet count.
Before, during, and after surgery it is important to measure regional oxygen saturation to ensure adequate oxygen delivery to the vital organs.
Mateo’s neonatologist uses an INVOS™ infant regional saturation sensor dorsally to reveal changes in kidney perfusion as well as an INVOS™ infant regional saturation sensor on the forehead to measure acute rSO2 changes in the cerebral tissue. This ability to detect acute alterations in rSO2, allow the care team to respond quickly.
Designed to help quickly identify desaturation events and improve the clinician’s ability to intervene sooner. Because seconds matter.
A soft, small sensor designed for fragile neonatal skin for use anywhere on the body. INVOS™ infant regional saturation sensors are applied to the skin’s surface, and are user and patient friendly, making monitoring of ischemic threats to the brain and body possible. By reporting venous weighted regional hemoglobin oxygen saturation (rSO2) in tissue directly beneath the sensor, INVOS™ technology reflects oxygen remaining after tissue demand has been met.
The INVOS™ 7100 regional oximetry system should not be used as the sole basis for diagnosis or therapy and is intended only as an adjunct in patient assessment
Chronic kidney disease (CKD) is the gradual loss of kidney function over time, preventing the filtration of toxins from the body. The presence of acute kidney injury (AKI) can progress to CKD, and further lead to end stage renal disease (ESRD). ESRD is the final, irreversible stage of CKD, where long-term pediatric renal replacement therapy is required, such as dialysis or a transplant.
While Mateo's FO stabilized, his kidney's failed to restore proper function, prompting the need for ongoing kidney support. Using chronic peritoneal dialysis (PD) therapy, this long-term support will keep Mateo stabilized, allowing time to grow and prepare for transplant.
After time to stabilize and grow on pCRRT, Mateo is cleared for surgical placement of an Argyle™* pediatric peritoneal dialysis catheter for regular and ongoing chronic kidney therapy. Unlike vascular intervention, the daily use of the Argyle™* PD catheter, paired with dialysate fluids, removes toxins through the peritoneal membrane in the abdominal wall.
The Argyle™ peritoneal dialysis (PD) catheters can be used for acute or chronic peritoneal dialysis. As each patient has varying anatomy, multiple configuration options help support surgical placement:
“Having our newborn son go into surgery shortly after birth was the most terrifying experience of our lives. The heartfelt support we got from everyone in the NICU was amazing. I don’t know how we would have made it through without their vigilant care and kind words of encouragement.
The technology was beyond astonishing. We watched a machine perform the bodily functions that our son could not. It kept him alive and fighting for a future we will now get to have with him. For that we are forever grateful.”
– Parent of NICU patient†
Support and partnerships
The NICU team is more than just a group of highly trained and specialized medical professionals. It’s a genuine smile at the sight of a milestone achieved. It’s an emotional and sometimes heartbreaking end to a shift. It’s a supportive shoulder and life coach to a concerned parent struggling with their new reality. It is a family. At Medtronic we strive to be more than just a medical technology company; we aim to be a supportive member of that family.
We offer online medical education and product training from our highly experienced clinical field representatives.
eLearning courses are available for many of our NICU products.
Medtronic offers an innovative and broad portfolio to support the NICU. Quality and sustainability are of utmost importance. We design our sensors, cables, monitors, ventilators, and dialysis products for seamless compatibility, durability, and ease of use – so you can put your focus on your patients not the devices.
We offer comprehensive, professional reimbursement services to secure and maintain coverage and payment.
† These narratives feature fictional patients, based on real clinical scenarios and product use. At all times, it is the professional responsibility of the practitioner to exercise independent clinical judgment in a particular situation. Changes in a patient’s disease and/or medications may alter the efficacy of the therapy, or product features. Results may vary.
Ronco C, Garzotto F, Ricci Z. CA.R.PE.DI.E.M. (Cardio-Renal Pediatric Dialysis Emergency Machine): evolution of continuous renal replacement therapies in infants. A personal journey. Pediatr Nephrol. 2012;27(8):1203-1211.
Carpediem™ dialysis system operator’s manual. Minneapolis, MN: Medtronic; 2021.
Vidal E, Cocchi E, Paglialonga F, et al. Continuous veno-venous hemodialysis using the cardio-renal pediatric dialysis emergency machine™: first clinical experiences. Blood Purif. 2018;31:1-7.
Garzotto, F, Zaccaria M, et al. Choice of catheter size for infants in continuous renal replacement therapy: Bigger is not always better. Pediatric Critical Care Medicine. 2019;20(3):170-179.
.Valerie Y. Chock, Laura A. Rose, Jeanet V. Mante, and Rajesh Punn. Near-infrared spectroscopy for detection of a significant patent ductus arteriosus. Pediatric Research, 2016;80(5): 675-680.