**4. Peritoneal dialysis**

It is a relatively simple technique, which can be used regardless of the age or weight of the child, including the newborn or the premature because of the difficulties of vascular access, the risk of bleeding, and hypotension in an extracorporeal circulation [9].

In case of respiratory distress, the child should be intubated and ventilated. Access to the peritoneum may be possible by placing a rigid catheter near the resuscitator at the patient's bedside or by placing a Tenckhoff catheter that is surgically introduced with subcutaneous tunneling and positioning control, under cover of antibiotic prophylaxis (2nd-generation IV cephalosporin, 20 mg/kg); it is heparinized at 500 IU/L.

The initial cycles last approximately 1 hour, with a volume of 10 mL/kg (at the beginning to avoid leakage), with a 30-minute break to reach in 2 to 3 days an optimal volume of recruitment of the peritoneal exchange surface, of the order of 30 to 50 mL/kg/cycle and according to the clinical needs and the patient's tolerance. Industrial solutions of neutral pH (bicarbonate buffer) are preferred, with isoosmolarity at first, and then use the intermediate osmolarity solution if necessary. A glucose concentration of 3.8 to 4.2% is required in the case of a high water overload. Risks of PD: leakage around the catheter, migration, catheter dysfunction, and peritonitis. Hemodynamic tolerance is generally correct; occasionally there is pain with abdominal filling.
