Medical milestone as 17-day-old baby undergoes lifesaving dialysis in Kisumu

Acute kidney injury (AKI) is becoming increasingly common among critically ill newborns.[Shutterstock]

For five agonising days, a newborn baby did not pass urine. The infant, only 17 days old, had already survived birth and been discharged home. But what should have been a period of bonding and recovery quickly turned into a medical emergency.

As the baby’s condition worsened, doctors at Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu discovered that the newborn had developed acute kidney injury (AKI), a potentially fatal condition in which the kidneys suddenly stop functioning properly.

In the past, such a diagnosis would almost certainly have triggered an urgent referral to Moi Teaching and Referral Hospital (MTRH) in Eldoret or Kenyatta National Hospital (KNH) in Nairobi, journeys that can take hours and often come with enormous financial and emotional strain for families already battling for a child’s survival.

This time, however, something different happened. The baby became the first newborn in Western Kenya to undergo peritoneal dialysis at JOOTRH, marking a major milestone not only for the hospital but also for neonatal healthcare in the region.

Historic milestone

For the team of doctors, nurses, surgeons and specialists who gathered around the tiny patient, the procedure represented years of preparation. For families across Western Kenya, it signalled something even more significant: the possibility of accessing lifesaving specialised care closer to home.

“This is a groundbreaking procedure that we have introduced since our elevation as a Level Six facility,” said JOOTRH Chief Executive Officer Dr Clinton Okise.

“It is the first time we are undertaking neonatal peritoneal dialysis in this hospital. We felt it was important to create awareness because many of these patients have traditionally been referred elsewhere, yet we now have the capacity to manage them here.”

The achievement comes at a time when newborn survival remains one of Kenya’s biggest healthcare challenges. According to the Ministry of Health statistics, approximately 30,000 newborns die annually in Kenya, while an estimated 92 newborn deaths occur every day from largely preventable causes.

Behind every statistic is a family. Behind every family is often a race against time, and in neonatal medicine, time can mean the difference between life and death.

Acute kidney injury is not a condition many parents are familiar with. Yet, according to specialists, it is increasingly common among critically ill newborns admitted to intensive care units.

Dr Lollah Mollah, a paediatric emergency and critical care specialist at JOOTRH, said the condition has become a significant contributor to illness among newborns. “For quite some time, we have been receiving children with acute kidney injuries, but we have always had to refer many of them to facilities such as KNH and MTRH because we lacked the capacity to provide dialysis services here,” he explained.

“However, following our elevation to a Level Six teaching and referral hospital and our transition into a state corporation, there was a growing need to provide highly specialised services closer to the communities we serve.”

The hospital receives referrals from counties within the Lake Region Economic Bloc and from neighbouring countries, including Uganda and Tanzania.

As the referral burden increased, doctors began noticing a worrying trend, with many newborns requiring specialised renal support losing valuable time during transfers. Some families struggled to raise transport costs, while others faced emotional trauma associated with moving critically ill infants over long distances. For some babies, delays proved fatal.

The challenge prompted hospital management to invest heavily in training healthcare workers and building specialised capacity. “It wasn’t something that happened overnight,” Dr Mollah said. “We looked at our numbers, studied the trends and realised that the need was there. We therefore embarked on a long-term plan involving specialised training for paediatricians, surgeons, anaesthetists, nurses, pharmacists and critical care teams.”

The result was the successful establishment of a multidisciplinary team capable of conducting neonatal peritoneal dialysis.

On the morning of the procedure, anticipation filled the operating theatre. Doctors understood they were about to undertake something that had never been done before at the facility.

The baby, now referred to by clinicians as “Patient Zero” because of the historic significance of the case, had already undergone extensive assessment. Tests confirmed severe kidney injury, and the medical team agreed that dialysis offered the best chance of survival.

A specialised catheter was acquired, and the theatre team was assembled. Experts from different institutions were also invited to observe and participate. In a rare show of collaboration, neonatologists and paediatric specialists from both public and private hospitals joined the procedure, including specialists from Aga Khan Hospital and Kisumu County Referral Hospital.

The goal was not simply to save one child but to build a regional network capable of supporting future patients.

“We wanted this to be bigger than JOOTRH,” Dr Mollah said. “These facilities often manage similar patients and refer them to us. They needed to become part of this journey.”

The surgery was successfully performed by paediatric surgeons, who inserted the peritoneal dialysis catheter. The baby was then transferred back to the High Dependency Unit, where dialysis commenced. Several cycles were completed successfully. “The baby remains critically ill,” Dr Mollah acknowledged.

“It takes time for the kidneys to recover, and there are complications we continue to monitor. However, we are encouraged by the progress so far.”

Preventable causes

One of the most striking revelations from JOOTRH specialists is that many cases of acute kidney injury in newborns are preventable.

According to Dr Mollah and his colleagues, inadequate breastfeeding and neonatal infections remain among the leading causes. “The commonest cause of acute kidney injury in our setting is failure to establish effective breastfeeding,” he explained.

“Many people do not immediately associate feeding challenges with kidney failure,  but dehydration caused by inadequate feeding can significantly affect kidney function.”

Neonatal sepsis also contributes significantly, with some infections originating during pregnancy or delivery.

Dr Sharon Ocharo, a paediatrician at JOOTRH, said parents should pay close attention to a newborn’s urine output, as it can provide an early warning sign.

“We expect a healthy newborn to produce six to eight wet nappies in 24 hours,” she said.

“If a baby is passing significantly less urine than expected, parents should seek medical attention immediately.”

She noted that some caregivers mistakenly view fewer wet nappies as a positive sign.

“Some mothers think having fewer wet nappies is a good thing because it means they are using fewer nappies,” she explained. “But that can actually be a danger sign.”

She emphasised that exclusive breastfeeding remains one of the most effective ways of protecting newborns from dehydration and related complications, while proper hygiene is equally important.

“When we prevent infections and ensure adequate feeding, we significantly reduce the risk of acute kidney injury,” she said.

While the procedure offers hope, it also highlights the financial realities facing families with critically ill newborns. Peritoneal dialysis is expensive.

According to JOOTRH specialists, the dialysis catheter alone costs approximately Sh30,000. In private hospitals, total treatment costs can range between Sh200,000 and Sh300,000.

For many families, such amounts are unaffordable. The hospital is therefore encouraging parents to maintain active Social Health Authority (SHA) coverage. “Without health insurance, this can be a very costly procedure,” said Dr Mollah. “We hope continued support from government and stakeholders will help ensure these services become more accessible.”

The hospital’s long-term strategy includes developing additional subspecialties and expanding critical care services.

Dr Okise said a skills-gap analysis has already been conducted to identify future needs. Where specialists are lacking, the hospital plans to sponsor training, while recruitment remains an option where services are urgently needed. “We are being very intentional about reducing neonatal and maternal mortality,” he said.

While celebrating the milestone, Dr Okise warned that sophisticated medical technology alone cannot solve Kenya’s maternal and newborn health challenges.

The achievement aligns closely with the government’s Every Woman Every Newborn Everywhere (EWENE) initiative, which seeks to reduce preventable maternal and newborn deaths.

The programme recognises that many deaths occur not because treatment does not exist, but because it is unavailable when and where it is needed.

By introducing neonatal peritoneal dialysis services, JOOTRH is helping bridge that gap. The milestone has already drawn praise from national health leaders.

Among those present was Dr Andrew Toro, the Ministry of Health’s Director of Clinical Services, who described the procedure as a significant advancement in specialised newborn care.

For one small baby whose kidneys stopped working before he was three weeks old, this medical first has become a beacon of hope for thousands of newborns who may one day need the same chance at life.