A warm September day was ending when Dr. Deepak Rajpoot’s phone rang. Normally, when the associate professor of pediatrics and newborn kidney specialist got calls from other doctors, they weren’t emergencies. But calls from Dr. Jay Gargus, an expert in genetic metabolic diseases, always were. Rajpoot picked up the phone. It was Gargus.
A 5-pound boy, born six hours earlier at a nearby hospital, had become very sleepy, a dangerous sign. An alert nurse contacted Gargus, and his and Rajpoot’s team swung into action.
This UCI team of pediatric and neonatal surgeons, nurses and technicians comprise one of the country’s few pediatric kidney disease centers, treating rare, life-threatening conditions that often appear without warning, just hours after birth. Working at the Antoci Center for Pediatric Urology and Nephrology, Gargus identifies genetic disorders that threaten newborn lives, while Rajpoot performs dialysis, reducing levels of blood toxins when these disorders disrupt the kidneys. Rajpoot started UCI’s pediatric kidney disease program in 1993. His interest in these disorders stemmed from a fascination with the immune system as a student. “Since most kidney diseases are due to immune system dysfunctions, and successful transplants rely on understanding the immune system, it was a natural fit for me,” he says.
This time, when the baby arrived at UCI Medical Center, he was in a coma. At the hospital where he was born, the staff had found levels of ammonia, a toxic chemical usually excreted by the kidneys, at eight times the normal level. The boy was breathing through a ventilator, but Rajpoot knew that only bringing down the ammonia levels quickly would save the newborn’s life.
Most medical centers don’t perform dialysis on a 5-pound infant. While adults have enough blood to weather dialysis-induced changes in volume, babies are a different story. The boy’s blood volume could fit into a teacup. A tiny drop in volume or pressure could kill him.
“Since blood volumes in infants are just 25 percent of adults, we need different machines and different catheters to make dialysis successful,” says Rajpoot. “Adult dialysis is usually done over a few hours, but with such low volumes of blood in babies, dialysis has to be very slow.”
The baby’s dialysis went on for nine hours, and it worked. The next morning, the newborn came out of his coma and his reflexes sprang to life. Rajpoot’s dialysis bought enough time for Gargus to pinpoint what caused the high ammonia levels. Gargus found the disorder: a transient enzyme shutdown. After Gargus’ medication regimen, the baby steadily gained weight. When he went home with his relieved mother two months later, the baby was eating and squirming like any healthy infant.