Volume 86 Number 6
Letters to the Editor
985
producing an effective cough. Since the production of an effective cough following chest physiotherapy is an essential part of the t r e a t m e n t of cystic fibrosis, an intracordal injection of Teflon (Teflon paste, Ethicon, Inc., Somerville, N. J.) is being considered as a therapeutic procedure. 2 Thomas F. Scanlin, M.D. Robert S. Shapiro, M.D. M. L. Rosenlund, M.D. University of Pennsylvania Medical Center The Children's Hospital of Philadelphia 34th & Civic Center Blvd. Philadelphia, Pa. 19104
REFERENCES 1. Dedo HH: The paralyzed larynx: An electromyographic study in dogs and humans, Laryngoscope 80:1455, 1970. 2. Dedo HH, Urrea RD, and Lawson L: Intracordal injection of Teflon in the treatment of 135 patients with dysphonia, Ann of Otol Rhinol Laryngol 82:661, 1973. Fig. 1. Peritoneal dialysis catheters, adult (top), pediatric (middle), and infant (bottom).
Peritoneal dialysis catheter for small infants To the Editor: For several years peritoneal dialysis has been successfully utilized in the treatment of children and adults with acute and chronic renal failure as well as for accidental ingestion of poisons. There are only a few reports describing the use of peritoneal dialysis in premature and term newborn infants. 14 In most of the newborn infants the dialysis catheter was placed surgically, t, ~ or a continuous flow peritoneal dialysis was attempted with inflow and outflow catheters. 3 In a few newborn infants the standard percutaneous catheter insertion technique has been described. 2, 4 The drainage holes in the standard adult and pediatric peritoneal dialysis catheter are limited to distal8.4 and 4.2 cm, respectively (Fig. 1) and must be placed well into the peritoneal cavity in order to maintain satisfactorily the dialysis. We have found that the intraperitoneal space in some newborn infants is too small to accommodate all of the drainage holes of the standard pediatric catheter. Thus we have experienced extraperitoneal leakage of the dialysis fluid, when the peritoneal cavity is being filled, as well as poor outflow, owing to intraperitoneal suction of air during the emptying phase of the dialysis cycle. Recently a peritoneal dialysis catheter for infants* has been designed to help overcome the difficulties mentioned above. The catheter has the same internal diameter as the standard adult and pediatric dialysis catheter, but the drainage holes are limited to the distal 2.1 cm (Fig. 1). Following distention of the *Trocath (infant size) McGaw Laboratories, Los Angeles, Calif.
peritoneal cavity with dialysis fluid the infant catheter was inserted percutaneously in the midline one-third of the distance from umbilicus to symphysis pubis. Successful peritoneal dialysis has been accomplished with this catheter in 4 infants with renal failure and/or overexpansion of vascular and extraceUular fluid volume. Two of the patients were boys and the other 2 girls; their weights varied between 2.6 and 6.5 kg. With the use of this catheter no leakage of fluid was observed through the drainage holes or around the catheter. The infant peritoneal dialysis catheter may be used fd'r peritoneal dialysis in newborn and small infants with greater success than other pediatric dialysis catheters with which we are familiar. Sudhir K. Anand, M.B.B.S. James D. Northway, M.D. Edwin L. Gresham, M.D. Indiana University School of Medicine I100 W. Michigan St. Indianapolis, Ind. 46202
REFERENCES 1. Segar WE, Gibson RK, and Rhamy R: Peritoneal dialysis in infants and small children, Pediatrics 27:603, 1961, 2. Lloyd-Still JD, and Atwelt JD: Renal failure in infant with special reference to the use of peritoneal dialysis, J Pediatr Surg 1:466, 1966. 3. Boda D, Muryani L, Altorjay I, and Veress I: Peritoneal dialysis in the treatment of hyaline membrane disease of the newborn premature infants, Acta Pediatr Scand 60:90, 1971. 4. Manley GL, and Collipp PD: Renal failure in the newborn: Treatment with peritoneal dialysis, Am J Dis -'~Child i15:107, 1968.
Letters to the Editor
985
producing an effective cough. Since the production of an effective cough following chest physiotherapy is an essential part of the t r e a t m e n t of cystic fibrosis, an intracordal injection of Teflon (Teflon paste, Ethicon, Inc., Somerville, N. J.) is being considered as a therapeutic procedure. 2 Thomas F. Scanlin, M.D. Robert S. Shapiro, M.D. M. L. Rosenlund, M.D. University of Pennsylvania Medical Center The Children's Hospital of Philadelphia 34th & Civic Center Blvd. Philadelphia, Pa. 19104
REFERENCES 1. Dedo HH: The paralyzed larynx: An electromyographic study in dogs and humans, Laryngoscope 80:1455, 1970. 2. Dedo HH, Urrea RD, and Lawson L: Intracordal injection of Teflon in the treatment of 135 patients with dysphonia, Ann of Otol Rhinol Laryngol 82:661, 1973. Fig. 1. Peritoneal dialysis catheters, adult (top), pediatric (middle), and infant (bottom).
Peritoneal dialysis catheter for small infants To the Editor: For several years peritoneal dialysis has been successfully utilized in the treatment of children and adults with acute and chronic renal failure as well as for accidental ingestion of poisons. There are only a few reports describing the use of peritoneal dialysis in premature and term newborn infants. 14 In most of the newborn infants the dialysis catheter was placed surgically, t, ~ or a continuous flow peritoneal dialysis was attempted with inflow and outflow catheters. 3 In a few newborn infants the standard percutaneous catheter insertion technique has been described. 2, 4 The drainage holes in the standard adult and pediatric peritoneal dialysis catheter are limited to distal8.4 and 4.2 cm, respectively (Fig. 1) and must be placed well into the peritoneal cavity in order to maintain satisfactorily the dialysis. We have found that the intraperitoneal space in some newborn infants is too small to accommodate all of the drainage holes of the standard pediatric catheter. Thus we have experienced extraperitoneal leakage of the dialysis fluid, when the peritoneal cavity is being filled, as well as poor outflow, owing to intraperitoneal suction of air during the emptying phase of the dialysis cycle. Recently a peritoneal dialysis catheter for infants* has been designed to help overcome the difficulties mentioned above. The catheter has the same internal diameter as the standard adult and pediatric dialysis catheter, but the drainage holes are limited to the distal 2.1 cm (Fig. 1). Following distention of the *Trocath (infant size) McGaw Laboratories, Los Angeles, Calif.
peritoneal cavity with dialysis fluid the infant catheter was inserted percutaneously in the midline one-third of the distance from umbilicus to symphysis pubis. Successful peritoneal dialysis has been accomplished with this catheter in 4 infants with renal failure and/or overexpansion of vascular and extraceUular fluid volume. Two of the patients were boys and the other 2 girls; their weights varied between 2.6 and 6.5 kg. With the use of this catheter no leakage of fluid was observed through the drainage holes or around the catheter. The infant peritoneal dialysis catheter may be used fd'r peritoneal dialysis in newborn and small infants with greater success than other pediatric dialysis catheters with which we are familiar. Sudhir K. Anand, M.B.B.S. James D. Northway, M.D. Edwin L. Gresham, M.D. Indiana University School of Medicine I100 W. Michigan St. Indianapolis, Ind. 46202
REFERENCES 1. Segar WE, Gibson RK, and Rhamy R: Peritoneal dialysis in infants and small children, Pediatrics 27:603, 1961, 2. Lloyd-Still JD, and Atwelt JD: Renal failure in infant with special reference to the use of peritoneal dialysis, J Pediatr Surg 1:466, 1966. 3. Boda D, Muryani L, Altorjay I, and Veress I: Peritoneal dialysis in the treatment of hyaline membrane disease of the newborn premature infants, Acta Pediatr Scand 60:90, 1971. 4. Manley GL, and Collipp PD: Renal failure in the newborn: Treatment with peritoneal dialysis, Am J Dis -'~Child i15:107, 1968.
