Fetal Diagnosis and Therapy最新文献

{"title":"Impact of a Stage-Based Classification on the Incidence of Fetal Growth Restriction, Preterm Birth Rates, and Birthweight in a Rural Community of Central India.","authors":"Lalit Kishore Sharma, Rijo Mathew Choorakuttil, Praveen Kumar Nirmalan","doi":"10.1159/000540199","DOIUrl":"10.1159/000540199","url":null,"abstract":"<p><strong>Introduction: </strong>The objective of this study was to determine the impact of the stage-based classification of fetal growth restriction (FGR) on the magnitude of FGR, preterm births (PTBs), and birthweight (BW) in a rural population of Madhya Pradesh in Central India.</p><p><strong>Methods: </strong>The program covered 168 public sector centers for pregnant women and infants that provided services to nearly 220,000 people. The third-trimester assessments included fetal biometry, growth and environment assessments, and Doppler assessments. Fetal growth was staged using the Barcelona protocol as stages 1-4 FGR, small for gestational age, and no FGR. The data from the last ultrasound assessment before childbirth were considered. Regular training programs covering preconception care, antenatal and postnatal care were organized in the local language for the public sector community health workers of the program district. Childbirth outcomes were collected from the obstetric service of the local public sector hospital.</p><p><strong>Results: </strong>The analysis included 1,229 pregnancies from 2019 to 2023. The overall magnitude of FGR using estimated fetal weight <10th centile was 19.61% and reduced to 13.34% with the stage-based classification. The magnitude of FGR using the stage-based classification reduced from 27.59% in 2019 to 8.95% in 2023. The PTB in the stage-based FGR subgroup declined from 35.0% in 2019 to 3.45% in 2023 and 96.55% of the stage 1 FGR babies in 2023 were delivered at term. The overall mean BW in the program area improved from 2,772.41 (357.11) g in 2019 to 2,819.68 (377.31) g in 2023. The perinatal mortality rate (8.95 per 1,000 pregnancies) in the program area for 2019-2023 was much lower than the 31.9 per 1,000 pregnancies reported for Madhya Pradesh.</p><p><strong>Conclusion: </strong>The change to a stage-based classification of FGR integrated with low-dose aspirin and fetal Doppler studies reduced the incidence of FGR and PTB and perinatal mortality and increased BW in this rural community.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"1-7"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Callosal Injuries in Cytomegalovirus Fetopathy: A Neurosonographic Study.","authors":"Karina Krajden Haratz, Gustavo Malinger, Hadas Miremberg, Joseph Hartoov, Igal Wolman, Ariel Jaffa, Michael Busilov, Roee Birnbaum","doi":"10.1159/000541794","DOIUrl":"10.1159/000541794","url":null,"abstract":"<p><strong>Introduction: </strong>Among the fetal brain anomalies described in cases of congenital infection, callosal insults are rarely cited in medical literature. The aim of this study was to describe the rate and pattern of callosal injury in cytomegalovirus (CMV) fetopathy.</p><p><strong>Methods: </strong>This retrospective study included fetuses with confirmed CMV-PCR, assessed in a single center. Demographic data including maternal seroconversion info were collected. Dedicated US including neurosonography was performed, with high frequency probes, using TV route whenever feasible. Fetal brain biometry including callosal length and the corpus callosum (CC)/OFD ratio was performed. Length below the 5th centile or morphological abnormalities were considered abnormal. Brain and body morphology were thoroughly assessed, and any abnormal finding reported.</p><p><strong>Results: </strong>Seventy-two patients were included in our cohort. In 76% infection occurred in the 1st T or periconceptional. In 12 patients, the exact time of infection was inconclusive, including two cases of secondary infection. In 34.7%, a callosal anomaly was observed and it was never isolated. CNS abnormalities included: periventricular hyperechogenicity (PVHE) 55.5%, calcifications 52%, ventriculomegaly 33%, periventricular pseudocysts 31.4%, occipital cysts 22.2%, echogenic ganglionic eminence 30.5%, lentostriatal vasculopathy 26.4%, sulcation abnormalities 22.2%, cerebellar findings 18% and HC below -2 SD 18%. In 19 cases, the CC was short with calcifications in four. In one case, the insult was severe and in another the CC was absent. The most common association with CC insult was PVHE (56%) and calcifications (52%).</p><p><strong>Conclusion: </strong>Although not referred as a classic brain structure affected by CMV infection, the CC was injured in one-third of our patients, including cases of late infection. The mechanism of disease and the prenatal patterns of callosal involvement in these cases appear to be different from the postnatal patterns and are not reversible. The presence of a callosal injury would imply a worse prognosis and significant increment to the risk of neurodevelopmental impairment.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"243-253"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142380402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased Risk of Persistent Pulmonary Hypertension of the Newborn in Twin Anaemia Polycythaemia Sequence Donors.","authors":"Margot J A van de Sande, Femke Slaghekke, Arjan B Te Pas, Ruben S G M Witlox, Enrico Lopriore, Lisanne S A Tollenaar","doi":"10.1159/000542493","DOIUrl":"10.1159/000542493","url":null,"abstract":"<p><strong>Introduction: </strong>This study aimed to describe the prevalence and risk factors for respiratory complications in monochorionic twins with twin anaemia polycythaemia sequence (TAPS).</p><p><strong>Methods: </strong>All neonates diagnosed with postnatal TAPS at our center between 2002 and 2023 were included in this retrospective study. The primary outcome was the prevalence of respiratory complications, including respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), and persistent pulmonary hypertension of the newborn (PPHN). Secondary outcomes included need of respiratory support during admission and a risk factor analysis for adverse respiratory outcome.</p><p><strong>Results: </strong>In our study of 100 postnatally diagnosed TAPS pregnancies, 32% (62/199) experienced RDS and 13% (25/199) had BPD, with no difference between donors and recipients. PPHN occurred in 7% of cases, more frequently in donors (11%, 11/100) than in recipients (3%, 3/100) (OR = 1.3, 95% CI: 0.2-2.6). Lower gestational age at birth and severe foetal anaemia were found to be significant independent risk factors associated with PPHN in TAPS twins (OR = 0.3, 95% CI: 0.1-0.5), respectively (OR = 1.9, 95% CI: 0.8-3.1).</p><p><strong>Conclusion: </strong>TAPS donor twins have a fourfold increased risk of PPHN due to anaemia compared to recipient twins. Given the life-threatening nature of PPHN, TAPS twins should be born in hospitals equipped to treat it.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"304-313"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Speckle Tracking Echocardiography in Twin Pregnancies and the Role of Global Longitudinal Strain and Peak Systolic Strain: A Systematic Review and Meta-Analysis.","authors":"Eline Meireson, Noortje H M van Oostrum, Judith O E H van Laar, Ellen Roets, Esmée M Bijnens, Liesbeth Lewi, Kristien Roelens","doi":"10.1159/000541981","DOIUrl":"10.1159/000541981","url":null,"abstract":"<p><strong>Introduction: </strong>Twin pregnancies are associated with an increased risk of perinatal morbidity and mortality. Pregnancy complications related to twins, such as fetal growth restriction, and twin-to-twin transfusion syndrome (TTTS), are associated with hemodynamic changes in the fetal heart. Two-dimensional speckle tracking echocardiography (2D STE) is a tool to evaluate fetal cardiac function. This paper aims to review the literature regarding global longitudinal strain (rate) and peak systolic strain (rate) assessed with 2D STE in twin pregnancies. Feasibility, frame rate, and angle of the fetal heart at the time of measurement were selected as secondary outcomes.</p><p><strong>Methods: </strong>The databases Medline, Embase, Scopus, and Web of Science were searched.</p><p><strong>Results: </strong>Seven articles met the inclusion criteria and selected all monochorionic diamniotic (MCDA) twins with TTTS as the study population. The global longitudinal strain in the right and left ventricle and the peak systolic strain in the right ventricle of the recipient MCDA twin are significantly decreased compared to the donor MCDA twin. 2D STE assessment was shown feasible and reproducible in MCDA pregnancies. Large heterogeneity in technical characteristics between the articles induces inconsistent results.</p><p><strong>Conclusion: </strong>Although feasible, the knowledge of 2D STE is very limited in twin pregnancy. Prospective studies are needed to evaluate the 2D STE assessment in uncomplicated twin pregnancies considering its possible additive value in the diagnostics of pregnancy-related pathologies.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"291-303"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Foetal Megacystis: A Practical Guide.","authors":"Vanessa El-Achi, Aniruddh Deshpande, Fergus Scott, Maria-Elisabeth Smet","doi":"10.1159/000543816","DOIUrl":"10.1159/000543816","url":null,"abstract":"<p><strong>Background: </strong>Foetal megacystis is the enlargement of the foetal bladder seen on prenatal ultrasound. Diagnosing the underlying cause of foetal megacystis in the antenatal period is often challenging due to the many possible underlying aetiologies, including various obstructive and non-obstructive causes.</p><p><strong>Summary: </strong>The detection of foetal megacystis leads to an extensive diagnostic conundrum. Counselling, prognostication, and prenatal management may prove challenging. Prenatal intervention has been trialled with limited success.</p><p><strong>Key messages: </strong>This review article aims to be a practical guide to assist with the diagnosis, management and counselling for foetal megacystis in each trimester. It summarizes the evidence for each differential diagnosis and how to distinguish between them.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"356-370"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143491441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prenatal Testing for Cystic Fibrosis in the Central Denmark Region (2012-2023).","authors":"Line Dahl Jeppesen, Stine Skibsted Rinder, Naja Becher, Lotte Andreasen, Puk Sandager, Ida Vogel","doi":"10.1159/000546547","DOIUrl":"10.1159/000546547","url":null,"abstract":"<p><strong>Introduction: </strong>Cystic fibrosis (CF) is a severe genetic disorder with a carrier frequency of 1 in 30. In Denmark, prenatal testing is offered when there is a family history of CF or ultrasound anomalies suggest an increased risk of the disease. This study evaluates indications for prenatal CF testing and their outcomes.</p><p><strong>Methods: </strong>Clinical indications and genetic results were analyzed for pregnancies undergoing CF testing in the Central Denmark Region between August 2012 and 2023. The data were categorized according to clinical indication.</p><p><strong>Results: </strong>Among 302 prenatal CF tests, echogenic bowel (EB) was the most frequent (44.7%, N = 135), leading to identification of one CF-affected fetus (0.7%). The second most common indication was EB together with non-CF-associated ultrasound findings (29.5%, N = 89), with no CF-affected fetuses. Known CF predisposition due to family history (15.6%, N = 47) identified five affected fetuses (10.6%) and 25 carriers (53.2%). No CF cases were detected in other included groups (N = 31).</p><p><strong>Conclusion: </strong>These data show that EB has a low positive predictive value for cystic fibrosis in the fetus (1:230) in a country with combined first-trimester screening but no systematic preconception or prenatal screening program for cystic fibrosis. Although the relative risk is increased compared to the general population (1:2,500), EB appears to be a marker of limited clinical utility. In settings without dedicated CF screening strategies, this underscores the importance of considering the most effective allocation of diagnostic resources.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"446-451"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144142026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cord Occlusion in Twin Reversed Arterial Perfusion Sequence: A Retrospective Study of Laser Photocoagulation versus Radiofrequency Ablation.","authors":"Emi J Komatsu, Catherine Hamzeh, Grace Hamadeh, Arlyn Llanes, Lisa M Korst, Ramen H Chmait","doi":"10.1159/000542494","DOIUrl":"10.1159/000542494","url":null,"abstract":"<p><strong>Introduction: </strong>Twin reversed arterial perfusion (TRAP) sequence is a rare condition complicating monozygotic multiple gestations. Prenatal management via umbilical cord occlusion (UCO) of the anomalous twin has been shown to improve pump twin survival. We compared outcomes of gestations with high-risk TRAP sequence treated with mid-trimester UCO using laser photocoagulation versus radiofrequency ablation (RFA).</p><p><strong>Methods: </strong>This is a retrospective, single-center, cohort study of all patients with high-risk TRAP sequence who underwent UCO from 2006-2023. High-risk criteria were defined as follows: larger abdominal circumference of the anomalous twin, polyhydramnios, critically abnormal Doppler waveforms in the pump twin, hydrops in the pump twin, and/or monoamniotic twins. The primary outcome was 30-day survival of the pump twin.</p><p><strong>Results: </strong>The 74 patients were divided equally between the laser and RFA groups. For the 2 groups, mean gestational age (GA) at UCO (20.5 ± 2.3 vs. 20.7 ± 3.1 weeks, p = 0.987) and mean GA at delivery (35.2 ± 4.6 vs. 34.5 ± 5.7 weeks, p = 0.812) were similar. The 30-day neonatal survival rate did not differ (91.9% [34/37] vs. 89.2% [33/37], OR: 1.37 [0.29-6.61], p = 0.692).</p><p><strong>Conclusion: </strong>No difference in 30-day neonatal survival was identified in patients with high-risk TRAP sequence who underwent mid-trimester UCO by laser versus RFA.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"320-327"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12129426/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142603074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prenatal Diagnosis and Management of Fetal Anemia Caused by Compound Heterozygous Hemoglobin Q-Thailand and Hemoglobin Constant Spring.","authors":"Theera Tongsong, Suchaya Luewan, Srimeunwai Ake-Sittipaisarn, Pimlak Charoenkwan, Theera Tongsong","doi":"10.1159/000546277","DOIUrl":"10.1159/000546277","url":null,"abstract":"<p><strong>Introduction: </strong>Compound heterozygous hemoglobin Q-Thailand (Hb QT) and hemoglobin Constant Spring (Hb CS) are rare hemoglobinopathies found occasionally in Southeast Asia. This condition is associated with varying degrees of anemia. This report aims to describe the prenatal diagnosis, natural course, and intrauterine treatment of Hb QT/CS disease, which is thought to be more severe during fetal development than to later in life.</p><p><strong>Case presentation: </strong>A 23-year-old pregnant woman who was at risk of fetal Hb E/β-thalassemia underwent a prenatal ultrasound examination and cordocentesis at 21 weeks of gestation. The ultrasound revealed signs of fetal anemia, including mild cardiomegaly and normal peak systolic velocity in the middle cerebral artery (MCA-PSV). Fetal hemoglobin analysis revealed a diagnosis of Hb QT/CS disease, which was confirmed by molecular study. A follow-up ultrasound at 23 weeks showed progressive cardiac enlargement, increased anemia, increased MCA-PSV, and mild hydropic changes. An intrauterine blood transfusion (IUT) was administered. Subsequent ultrasounds demonstrated a complete resolution of the hydropic signs. The fetus required only one IUT, and the anemia improved spontaneously later in the pregnancy. The woman delivered a healthy male newborn vaginally at 39 weeks of gestation.</p><p><strong>Conclusion: </strong>Hb QT/CS disease can lead to fetal anemia and hydrops fetalis. However, the severity of anemia in this case improves as the pregnancy progresses toward term. If the fetus survives the critical period in utero without significant organ damage from anemia, a favorable long-term prognosis is possible. This report is the first to describe the prenatal diagnosis, natural course, and intrauterine treatment of Hb QT/CS disease with a successful outcome.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"539-546"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960437","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac Structural and Functional Assessment of Monochorionic Twin Pregnancies Complicated by Type II and Type III Selective Fetal Growth Restriction.","authors":"Jessian L Munoz, Jessian L Munoz, Betul Yilmaz Furtun, Cara Buskmiller, Magdalena Sanz Cortes, Roopali V Donepudi, Michael A Belfort, Ahmed A Nassr","doi":"10.1159/000545880","DOIUrl":"10.1159/000545880","url":null,"abstract":"<p><strong>Introduction: </strong>Selective fetal growth restriction (sFGR) complicates 10-15% of monochorionic twin gestations. Prior studies reported neonatal cardiac hypertrophy present in 25% of twins impacted by sFGR, most commonly the larger twin (80%). Our primary objective was to characterize fetal cardiac structural and functional echocardiogram findings in sFGR twins.</p><p><strong>Methods: </strong>A retrospective cohort analysis was performed of monochorionic twin pregnancies complicated by type II or type III sFGR managed and delivered at a single tertiary center from 2015 to 2023. Patients diagnosed with twin to twin transfusion syndrome, twin anemia-polycythemia sequence, or undergoing laser treatment for any indication were excluded. All twin pairs underwent fetal echocardiogram by board-certified pediatric cardiologists at our center. In cases of abnormal fetal echocardiograms, a pediatric echocardiogram was performed after birth. Clinically relevant data were obtained from electronic medical records. Right and left myocardial performance index (MPI) were calculated incorporating ejection, isovolumetric contraction, and isovolumetric relaxation times as well as combined cardiac output, cardiac hypertrophy, and tricuspid regurgitation.</p><p><strong>Results: </strong>During the study period, 35 pregnancies complicated by type II or type III sFGR were managed by our team. Two patients were excluded as they did not undergo fetal echocardiograms as planned. The remaining 33 twin pairs underwent echocardiogram analysis at 20 weeks ± 6 days on average. Compared to the sFGR fetuses, appropriate for gestational age (AGA) fetuses were more likely to have tricuspid regurgitation (TR, 37 vs. 9%, p = 0.02), right ventricular hypertrophy (RVH, 42 vs. 9%, p = 0.003), left ventricular hypertrophy (31 vs. 3%, p = 0.006), elevated right MPI (0.36 [0.26, 0.49] vs. 0.29 [0.24, 0.35], p = 0.03), and elevated left MPI (0.32 [0.29, 0.47] vs. 0.29 [0.25, 0.35], p = 0.02). No difference was noted in combined cardiac output (534 [483, 596] vs. 522 [447, 596], p = 0.41). At birth, 55% (6/11) of AGA fetuses with abnormal fetal echocardiograms had RVH and TR compared to 25% (1/4) of sFGR fetuses.</p><p><strong>Conclusion: </strong>In this cohort of expectantly managed monochorionic twins complicated by type II and type III sFGR, larger twins were noted to have several findings consistent with hemodynamic changes which could reflect cardiac overload in the prenatal period. In addition, these may persist during neonatal life. Further assessment of neonatal and pediatric outcomes is needed to determine the long-term implications of these sonographic findings.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"439-445"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143960434","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequential Amnioinfusion Protocol for Treating Fetal Renal Failure: Impact on Survival and Transition to Renal Transplantation.","authors":"Kevin Magee, Kristen Lee Moriarty, Grant Delanoy, Paxton Alexander, Albert Quan, Ella Meyer, Clair Schwendeman, Erica Hammer, Elizabeth A Morgan, Timothy M Crombleholme","doi":"10.1159/000546454","DOIUrl":"10.1159/000546454","url":null,"abstract":"<p><strong>Introduction: </strong>Fetal renal failure (FRF) is a challenging antenatal diagnosis associated with insufficient pulmonary development and potential compromise for the future possibility of dialysis and kidney transplantation. Even in cases in which lung development can be fostered by serial amnioinfusions (AIs), infants who are born prematurely may not qualify for peritoneal dialysis due to weight criteria.</p><p><strong>Methods: </strong>We describe our outcomes after introducing an integrated approach at two institutions to prenatal management of FRF with a serial AI protocol and postnatal management with peritoneal dialysis. Our primary endpoint was survival to 6 months of age with successful dialysis, and the secondary outcomes included the ability to transition to renal transplantation.</p><p><strong>Results: </strong>The mean gestational age at which AIs were initiated was 23.3 ± 2.32 weeks for the whole cohort. There was no significant difference between survivors (22.51 ± 1.70 weeks) and non-survivors (23.31 ± 2.69 weeks, p = 0.339) in the gestational age at initiation of AIs. The mean gestational age at delivery for the entire cohort was 34.8 ± 2.62 weeks, and there was a trend toward but did not achieve significance between survivors (35.0 ± 1.60 weeks) compared to non-survivors (33.17 ± 3.34 weeks, p = 0.066). Survival to delivery was 100% for the total AI cohort (n = 30).</p><p><strong>Conclusion: </strong>A total of 83% of patients alive at 48 h survived the neonatal period and of those surviving the neonatal period, 62.5% survived a minimum of 6 months on outpatient peritoneal dialysis (PD). This series also established that PD can be successfully performed in neonates as small as 1,500 g. Four patients have successfully undergone renal transplantation. Serial AIs for FRF offer the potential, not only in neonatal pulmonary survival but also long-term survival to kidney transplantation.</p>","PeriodicalId":12189,"journal":{"name":"Fetal Diagnosis and Therapy","volume":" ","pages":"509-520"},"PeriodicalIF":1.6,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144126857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}