Serial Amnioinfusion Therapy for Treatment of Congenital Bilateral Renal Agenesis-A Systematic Review.

Abstract

Serial amnioinfusion therapy (SAT) has emerged as a potential mitigatory intervention to adverse perinatal outcomes associated with congenital bilateral renal agenesis (BRA). However, its efficacy, safety, and ethical implications warrant thorough evaluation. This systematic review, developed according to PRISMA guidelines, analyzes the published data on outcomes of SAT for BRA and explores its implications. Inclusion criteria were a diagnosis of bilateral renal agenesis, therapeutic use of amnioinfusion, amnioinfusion procedure, and individual maternal and fetal outcome reports. A total of 192 published studies were identified. Among these, 11 full texts were included (N = 40). Only cases resulting in live birth and with reported maternal and neonatal outcomes were analyzed. The average number of amnioinfusions per mother was 9 (n = 23; range 1-26 infusions). Median gestational age at delivery was 33.4 weeks (n = 40; range 23.7-36.8 weeks). APGAR scores (n = 14) at 1 and 5 min were 4 and 6, respectively. Almost half of newborns died within 33 days of life (n = 19) and 7 (17.5%) survived at the time of original publication. Overall neonatal mortality was 82.5% (33 of 40). These findings suggest that SAT for BRA improves the chances of neonatal survival in the first few days to weeks of life but not consistently beyond that time. Additional advances in neonatal care are needed to improve long-term outcomes in peripartum survivors.