Survival of neonates born with kidney failure during the initial hospitalization

Claes, Donna; Richardson, Troy; Harer, Matthew W.; Keswani, Mahima; Neu, Alicia M.; Mahon, Allison C Redpath; Somers, Michael J.; Traum, Avram Z.; Warady, Bradley A.

doi:10.1007/s00467-022-05626-x

Cited by 4 publications

(3 citation statements)

References 25 publications

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“…In this study, mortality during the initial hospitalization was reported to be 23.9%. Mortality rates differed by birth weight, with 43.8% mortality among infants weighing less than 1800 g, 22.1% among those weighing 1800 to 2500 g, and 22.5% among those weighing more than 2500 g . In the RAFT trial, 83% of newborns weighed less than 2500 g and similarly, lower birth weight was also associated with higher mortality.…”

Section: Discussionmentioning

confidence: 98%

“…Data from the US Renal Data System registry of infants starting peritoneal dialysis before 1 month of age from 2000 to 2014 reported 1-and 5-year survival as 86.1% and 74.6%, respectively, but these data do not account for infants who died before hospital discharge or prior to the initiation of long-term dialysis. 14 Claes et al 15 among those weighing 1800 to 2500 g, and 22.5% among those weighing more than 2500 g. 15 In the RAFT trial, 83% of newborns weighed less than 2500 g and similarly, lower birth weight was also associated with higher mortality. The higher mortality rate before hospital discharge suggests that infants born without kidneys experience life-limiting complications at a higher rate than infants with kidney failure from all causes.…”

Section: Discussionmentioning

confidence: 99%

“…Data from the US Renal Data System registry of infants starting peritoneal dialysis before 1 month of age from 2000 to 2014 reported 1- and 5-year survival as 86.1% and 74.6%, respectively, but these data do not account for infants who died before hospital discharge or prior to the initiation of long-term dialysis . Claes et al recently published neonatal survival data for a cohort of 213 infants who are perhaps more, but not completely, comparable with RAFT neonates; those born with kidney failure (not restricted to bilateral renal agenesis) at 52 US children’s hospitals whose data were collected via the Children’s Hospital Association Pediatric Health Information System database. In this study, mortality during the initial hospitalization was reported to be 23.9%.…”

Section: Discussionmentioning

confidence: 99%

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Neonatal Survival After Serial Amnioinfusions for Bilateral Renal Agenesis

Miller,

Baschat,

Rosner

et al. 2023

JAMA

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ImportanceEarly 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.ObjectiveTo assess neonatal outcomes of serial amnioinfusions initiated before 26 weeks’ gestation to mitigate lethal pulmonary hypoplasia.Design, Setting, and ParticipantsProspective, 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.ExposureEnrolled 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 MeasuresThe primary end point was postnatal infant survival to 14 days of life or longer with dialysis access placement.ResultsThe 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 RelevanceSerial 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 RegistrationClinicalTrials.gov Identifier: NCT03101891

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

“…Data from the US Renal Data System registry of infants starting peritoneal dialysis before 1 month of age from 2000 to 2014 reported 1- and 5-year survival as 86.1% and 74.6%, respectively, but these data do not account for infants who died before hospital discharge or prior to the initiation of long-term dialysis . Claes et al recently published neonatal survival data for a cohort of 213 infants who are perhaps more, but not completely, comparable with RAFT neonates; those born with kidney failure (not restricted to bilateral renal agenesis) at 52 US children’s hospitals whose data were collected via the Children’s Hospital Association Pediatric Health Information System database. In this study, mortality during the initial hospitalization was reported to be 23.9%.…”

Section: Discussionmentioning

confidence: 99%

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