2 I associated with atrial and ventricular septal defect. Preoperative renal function evaluation was normal with serum creatinine of 30 µmol/L, blood urea nitrogen of 2.2 mmol/L; urine analysis was normal as well as renal Doppler ultrasound. Preoperative weight was 3.9 kg. The corrective cardiac surgery was performed at 8 days of life. During extracorporeal circulation that lasted 198 minutes, a modiﬁed ultraﬁltration used during 36 minutes drained 275 milliliters of ﬂuid. The aortic cross was clamped during 60 minutes. At the end of the surgery, ﬂuid balance was positive of 550 cc. During the follow-up, the patient had multiples episodes of worsening renal function and ﬂuid retention despite diuretic therapy. It was a prerenal dysfunction with a fractional excretion of sodium of less than 1% consistent with a hemodynamic cause. The ﬁrst episode of renal dysfunction began immediately after cardiac surgery. Serum creatinine concentration increased from a preoperative value of 30 µmol/L to 107 µmol/L on day 1 with a maximum of 120 µmol/L on day 4 and returned to normal with value of 30 µmol/L on day 11 after surgery. In parallel, the cardiac function remained diﬃcult to stabilize after the surgery with a decrease in the contractility of the right ventricle noted on day 9 postsurgery. Three weeks postsurgery, the patient had remained on ventilatory support because of persistent cardiac failure mainly due to right ventricular dysfunction. On post-operative day 23, the serum creatinine concentration reached a peak of 105 µmol/L, and the patient’s weight was 60% over his birth weight. Low volume peritoneal dialysis through a surgically placed cuﬀed Tenckhoﬀ catheter was initiated with 10 mL/kg exchange volume and the dwell time was one hour. Glucose-based peritoneal dialysis solutions were used with concentration of glucose of 1.5% and 2.5%. After repetitive episodes of blood pressure drop following the drainage with incidental hypoxemia and diﬃculties with dialysate leaks, peritoneal dialysis had to be discontinued 3 days later. The peritoneal drain was kept in place and used for continuous drainage over a period of 2 months from day 23 to day 85 in an attempt to prevent or treat signiﬁcant ﬂuid accumulation and was removed because of an unexplained fever despite multiples investigations. Over this period, there were no signs of infection at entry site or peritonitis and peritoneal ﬂuid cultures remained negative. In order to determine the eﬀect of peritoneal drainage on ﬂuid balance and diuresis, we analyzed the data from the week prior and following the discontinuation of the peritoneal drainage on day 85 (Table 1). During this period, the patient remained stable as shown by similar use of inotropic medication (milrinone, digoxin, clonidine) and PEdiatric LOgistic Dysfunction score (PELOD) [6]. The daily dose of furosemide medication was also similar over the 2 weeks period (4.5 mg ± 0 and 4.5 ± 1.5 mg/kg/day used as boluses). Diuresis remained unchanged through- out the period analyzed (2.6 ± 0.7 cc/kg/hour and 3.1 ± 0.5 cc/kg/hour); yet the median daily in and out ﬂuid balance increased from +53 mL/day (range: −309 to +174) with the peritoneal drain to +131 mL/day (range −150 to +339) after the removal of the drain; the median drained ﬂuid volume was 1 cc/kg/hour (range: 0.3–2.3). The urinary sodium Case Reports in Medicine Table 1: Eﬀect of the peritoneal drain on ﬂuid balance after cardiac surgery. During the week preceding and following peritoneal drain removal we report the clinical severity data (PELOD score), diuretic therapy, parameters of the ﬂuid balance, and renal function. Data were compared with the bilateral student T test. P-value < .05 was considered statistically signiﬁcant. PELOD score Furosemide (mg/kg/day) In/out Fluid balance (mL/day) Urine output (mL/kg/hr) Drain output (mL/kg/hr) FENa∗ Serum creatinine (µmol/L) +53 (−309, +174) +131 (−150, +339) .06 Peritoneal drain 8 ± 5 4.5 ± 0 2.6 ± 0.7 1 (0.3, 2.3) <10 40 ± 6 No peritoneal drain 7 ± 5 4.5 ± 1.5 P value .63 .50 3.1 ± 0.5 0 <10 45 ± 9 .19 .22 ∗FENa: fractional excretion of sodium. (Results are expressed as median and range for ﬂuid balance, drain and urine output and as mean and SD for Pelod score, furosemide therapy and renal function). concentration remained below 10 mmol/L with fractional excretion of sodium of less than 1%, and serum creatinine level was comparable over the two weeks period (40 ± 6 and 45 ± 9 µmol/L). Although peritoneal drainage slightly improved the ﬂuid balance, the clinical course of the patient worsened; he remained ventilated because of both cardiac and thoracic oedema and died on day 118 after surgery from decompensated cardiac failure, sepsis, pulmonary infection, and worsening renal function. 3. Discussion We present the case of an infant in whom a continuous peri- toneal drain was used successfully to assist the management of ﬂuid overload after cardiac surgery without decreasing urine output nor impairing renal function. Fluid overload is a common complication following cardiac surgery in infants. Several treatments have been proposed to treat ﬂuid overload in the context of cardiac failure and cardiac surgery including diuretics and peritoneal dialysis [1–5]. Most patients with heart failure who require diuretic therapy are treated with loop diuretics as they are powerful agents [7]. However, despite high dose of furosemide up to 5 mg/kg/day that were used in this patient, there was a low responsiveness to this medication as shown by a persistently low urine ratio of Na/K < 1, a fractional sodium excretion of less than 1% and urine output not exceeding 3 mL/kg/day. In cases of acute kidney injury and persistent ﬂuid overload refractory to diuretic therapy, peritoneal dialysis is a safe and adequate treatment. However, complications such as leaks, ultraﬁltration failure in patient with hemodynamic