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Neonatal survival and kidney function after prenatal interventions for obstructive uropathies
- Department of Paediatics, Immunology and Nephrology, Polish Mother’s Memorial Hospital Research Institute of Lodz, Lodz, Poland
- Department of Gynecology, Fertility and Fetal Therapy, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
- Department of Intensive Therapy and Congenital Malformations of Newborns and Infants, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
- Department of Neonatology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
- Department of Surgery, Urology and Transplantology, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
- Department of Imaging Diagnostic, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
- Medical Laboratory Diagnostic Centre, Polish Mother’s Memorial Hospital Research Institute, Lodz, Poland
- Institute of Information Technology, Lodz University of Technology, Lodz, Poland
open access
Abstract
Objectives: Prenatal interventions in LUTO (lower urinary tract obstruction) usually are still question of a debate between gynaecologist and paediatric nephrologist. We aimed the study to assess the early survival rate and renal outcome in LUTO foetuses.
Material and methods: The study was a prospective data analysis of 39 foetuses from singleton pregnancies. All pregnant women with LUTO in the foetus were qualified for VAS based on a local practice. The mean time of first urine analysis ranged between 13–30 weeks of pregnancy. Primary end-point analysis included live birth, 28d-survival, pulmonary and renal function assessment in neonatal period.
Results: From initial number of 39, six patients miscarried before the procedure was performed. Overall, 33 VAS were performer at the mean 21 week of pregnancy (range 14–30 weeks). 25/39 foetuses survived until delivery. Three neonates died in first 3 days of life. In the first month 3 children required peritoneal dialysis, but at 28 day all children were dialysis-free. Overall survival rate at 28 day was 56%. Renal function preservation of the initial group (39) turned out to be low — 18% (7/39).
Conclusions: Our study showed average survival curves and complications. LUTO in the foetus had mostly unfavourable outcome in the neonatal period. The prenatal intervention did not increase it significantly and did not guarantee the preservation of normal kidney function.
Abstract
Objectives: Prenatal interventions in LUTO (lower urinary tract obstruction) usually are still question of a debate between gynaecologist and paediatric nephrologist. We aimed the study to assess the early survival rate and renal outcome in LUTO foetuses.
Material and methods: The study was a prospective data analysis of 39 foetuses from singleton pregnancies. All pregnant women with LUTO in the foetus were qualified for VAS based on a local practice. The mean time of first urine analysis ranged between 13–30 weeks of pregnancy. Primary end-point analysis included live birth, 28d-survival, pulmonary and renal function assessment in neonatal period.
Results: From initial number of 39, six patients miscarried before the procedure was performed. Overall, 33 VAS were performer at the mean 21 week of pregnancy (range 14–30 weeks). 25/39 foetuses survived until delivery. Three neonates died in first 3 days of life. In the first month 3 children required peritoneal dialysis, but at 28 day all children were dialysis-free. Overall survival rate at 28 day was 56%. Renal function preservation of the initial group (39) turned out to be low — 18% (7/39).
Conclusions: Our study showed average survival curves and complications. LUTO in the foetus had mostly unfavourable outcome in the neonatal period. The prenatal intervention did not increase it significantly and did not guarantee the preservation of normal kidney function.
Keywords
obstructive uropathy; posterior urethral valves; vesico-amniotic shunting; kidney function; prenatal; neonate
Title
Neonatal survival and kidney function after prenatal interventions for obstructive uropathies
Journal
Issue
Article type
Research paper
Pages
416-422
Published online
2019-07-26
Page views
1474
Article views/downloads
1041
DOI
Bibliographic record
Ginekol Pol 2019;90(7):416-422.
Keywords
obstructive uropathy
posterior urethral valves
vesico-amniotic shunting
kidney function
prenatal
neonate
Authors
Marcin Tkaczyk
Malgorzata Stanczyk
Waldemar Krzeszowski
Justyna Wojtera
Magdalena Litwinska
Katarzyna Fortecka-Piestrzeniewicz
Tomasz Talar
Barbara Pawlowska
Dariusz Olejniczak
Michal Podgorski
Rafal Swiechowski
Adrian Krygier
Agnieszka Wosiak
Krzysztof Szaflik
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