We read with great interest the recent article by Okan, et al. [1] published in Indian Pediatrics which concluded that peritoneal dialysis (PD) is technically feasible in very low birthweight (VLBW) and extremely low birthweight (ELBW) neonates despite a high mortality rate in the studied population (81%). We also agree that peritoneal dialysis in neonates, and particularly in preterm neonates, is challenging and is still evolving with only few anecdotal case report and case series till date indicating its feasibility in preterm neonates. Further, due to the physiological compromise (small size, poor hemodynamic stability and tendency of coagulopathy), overall prognosis in preterm neonates undergoing peritoneal dialysis is grimmer as compared to their term counterparts as well as older children. This study was need based and addressed a very important and clinically relevant issue. However, we have few concerns related to the article which we would like to get the clarification from the author.

1. In Table I of the article, we were intrigued to note that patent ductus arteriosus (PDA) led to acute kidney injury on day 1, and that too requiring PD [1]. We would like to know the exact clinical/ laboratory criteria for doing peritoneal dialysis in that baby.

2. Many babies (50% of the study population) had undergone PD due to necrotizing enterocolitis (NEC) as one of the underlying causes (Table I) [1]. The result section also mentions that 5 (23.8%) of babies had perforated NEC (stage IIIb) [1]. As the presence of NEC, particularly perforated NEC is a contraindication to do PD [2], why was it carried out in these babies? This is important, as approximately 80% of the babies who had undergone PD with NEC as underlying cause, ultimately died [1].

REFERENCES

1. Okan MA, Topçuoglu S, Karadag NN, Ozalkaya E,  Karatepe HO, Vardar G, et al. Acute peritoneal dialysis in premature infants. Indian Pediatr. 2020;57:420 2.

2. Spector BL, Misurac JM. Renal replacement therapy in neonates. Neoreviews. 2019;20:e697 710.