First experience of hemadsorption with HA60 cartridges in newborns and small infants with septic shock: a case series.

Background: Blood purification techniques are rarely used in low-weight pediatric patients because extracorporeal circuits and devices designed for adults may expose neonates and infants to significant adverse events. Recently, hemoadsorption cartridges with low priming volumes (Jafron®) have become available. Case description: We report a descriptive case series of four pediatric patients treated with hemoadsorption using HA60 cartridges, including two neonates (2.8 kg and 3.5 kg) and two infants (7 kg and 10 kg). All patients were admitted to the PICU with septic shock and received standard therapy, including broad-spectrum antibiotics and vasoactive agents. Two of the four patients required extracorporeal membrane oxygenation (ECMO) because of severe respiratory and circulatory failure. In all patients, continuous renal replacement therapy (CRRT) was initiated for acute kidney injury and/or fluid overload, and HA60 hemoadsorption was added. Clinical and laboratory parameters, together with vasoactive drug requirements, were recorded from the initiation of hemoadsorption until the end of treatment. Three of the four patients survived. Discussion and conclusions: Our findings are limited to describing the feasibility and safety of HA60 hemoadsorption in neonates and small infants with septic shock, as well as the logistical aspects associated with the use of these novel extracorporeal technologies, rather than demonstrating clinical efficacy. No major adverse events were observed. Within this perspective, the fatal outcome observed in Case 1 was considered unrelated to the hemoadsorption procedure itself. Given the descriptive nature of the study and the presence of multiple concomitant therapies, no conclusions regarding efficacy can be drawn. Larger studies are needed to confirm these preliminary observations.