التفاصيل البيبلوغرافية
| العنوان: |
Neonatal Survival After Serial Amnioinfusions for Bilateral Renal Agenesis: The Renal Anhydramnios Fetal Therapy Trial. |
| المؤلفون: |
Miller, Jena L., Baschat, Ahmet A., Rosner, Mara, Blumenfeld, Yair J., Moldenhauer, Julie S., Johnson, Anthony, Schenone, Mauro H., Zaretsky, Michael V., Chmait, Ramen H., Gonzalez, Juan M., Miller, Russell S., Moon-Grady, Anita J., Bendel-Stenzel, Ellen, Keiser, Amaris M., Avadhani, Radhika, Jelin, Angie C., Davis, Jonathan M., Warren, Daniel S., Hanley, Daniel F., Watkins, Joslynn A. |
| المصدر: |
JAMA: Journal of the American Medical Association; 12/5/2023, Vol. 330 Issue 21, p2096-2105, 10p |
| مصطلحات موضوعية: |
PULMONARY hypoplasia, AMNIOTIC liquid, PREGNANCY complications, LUNG development, BIRTH weight, POLYHYDRAMNIOS, AGENESIS of corpus callosum |
| مستخلص: |
Key Points: Question: In pregnancies complicated by anhydramnios due to fetal bilateral renal agenesis, do serial amnioinfusions instituted before 26 weeks' gestation mitigate lethal pulmonary hypoplasia in neonates? Findings: In this nonrandomized clinical trial, 82% of live-born infants survived to 14 days of life or longer and placement of dialysis access, but longer-term neonatal survival was reduced. Serial amnioinfusions were not associated with severe maternal complications. Meaning: Prenatal serial amnioinfusions can mitigate neonatal lethal pulmonary hypoplasia in neonates with bilateral renal agenesis, but infants face substantial morbidity independent of lung function. Importance: Early anhydramnios during pregnancy, resulting from fetal bilateral renal agenesis, causes lethal pulmonary hypoplasia in neonates. Restoring amniotic fluid via serial amnioinfusions may promote lung development, enabling survival. Objective: To assess neonatal outcomes of serial amnioinfusions initiated before 26 weeks' gestation to mitigate lethal pulmonary hypoplasia. Design, Setting, and Participants: Prospective, nonrandomized clinical trial conducted at 9 US fetal therapy centers between December 2018 and July 2022. Outcomes are reported for 21 maternal-fetal pairs with confirmed anhydramnios due to isolated fetal bilateral renal agenesis without other identified congenital anomalies. Exposure: Enrolled participants initiated ultrasound-guided percutaneous amnioinfusions of isotonic fluid before 26 weeks' gestation, with frequency of infusions individualized to maintain normal amniotic fluid levels for gestational age. Main Outcomes and Measures: The primary end point was postnatal infant survival to 14 days of life or longer with dialysis access placement. Results: The trial was stopped early based on an interim analysis of 18 maternal-fetal pairs given concern about neonatal morbidity and mortality beyond the primary end point despite demonstration of the efficacy of the intervention. There were 17 live births (94%), with a median gestational age at delivery of 32 weeks, 4 days (IQR, 32-34 weeks). All participants delivered prior to 37 weeks' gestation. The primary outcome was achieved in 14 (82%) of 17 live-born infants (95% CI, 44%-99%). Factors associated with survival to the primary outcome included a higher number of amnioinfusions (P =.01), gestational age greater than 32 weeks (P =.005), and higher birth weight (P =.03). Only 6 (35%) of the 17 neonates born alive survived to hospital discharge while receiving peritoneal dialysis at a median age of 24 weeks of life (range, 12-32 weeks). Conclusions and Relevance: Serial amnioinfusions mitigated lethal pulmonary hypoplasia but were associated with preterm delivery. The lower rate of survival to discharge highlights the additional mortality burden independent of lung function. Additional long-term data are needed to fully characterize the outcomes in surviving neonates and assess the morbidity and mortality burden. Trial Registration: ClinicalTrials.gov Identifier: NCT03101891 This prospective, nonrandomized clinical trial assesses neonatal outcomes after serial amnioinfusions initiated before 26 weeks' gestation to mitigate lethal pulmonary hypoplasia in pregnancies complicated by bilateral renal agenesis. [ABSTRACT FROM AUTHOR] |
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| قاعدة البيانات: |
Complementary Index |
