P Danziger1, D R Berman2,3, K Luckritz1,4, K Arbour5, N Laventhal1,6,7. 1. Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA. 2. Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA. 3. Division of Maternal-Fetal Medicine, University of Michigan, Ann Arbor, MI, USA. 4. Division of Pediatric Nephrology, University of Michigan, Ann Arbor, MI, USA. 5. Columbia University School of Continuing Education Bioethics Master's Program, New York, NY, USA. 6. Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA. 7. Division of Neonatal-Perinatal Medicine, University of Michigan, Ann Arbor, MI, USA.
Abstract
OBJECTIVE: Decision-making for pregnancies complicated by severe congenital anomalies of the kidneys and urinary tract (CAKUT) are ethically challenging, partly because the outcomes are not well studied. STUDY DESIGN: Retrospective cohort study of severe cases of CAKUT over 14 years. RESULTS: Seventy-one of the 108 cases could be completely analyzed. Forty-six percent (n=33) infants were live-born; one-third (n=11) survived to 12 months. Twice as many non-surviving infants received a trial of therapy vs comfort care only. Two-thirds of non-survivors who received a trial of therapy died within the first 9 h of life. Live-born infants faced morbidities such as pneumothorax and neonatal dialysis. CONCLUSIONS: Over half of pregnancies complicated by severe CAKUT ended in termination or stillbirth, but one-third of live-born infants survived to 12 months and the majority of non-survivors died within hours. This may allay concerns about prolonged and futile intensive care for parents considering a trial of therapy.
OBJECTIVE: Decision-making for pregnancies complicated by severe congenital anomalies of the kidneys and urinary tract (CAKUT) are ethically challenging, partly because the outcomes are not well studied. STUDY DESIGN: Retrospective cohort study of severe cases of CAKUT over 14 years. RESULTS: Seventy-one of the 108 cases could be completely analyzed. Forty-six percent (n=33) infants were live-born; one-third (n=11) survived to 12 months. Twice as many non-surviving infants received a trial of therapy vs comfort care only. Two-thirds of non-survivors who received a trial of therapy died within the first 9 h of life. Live-born infants faced morbidities such as pneumothorax and neonatal dialysis. CONCLUSIONS: Over half of pregnancies complicated by severe CAKUT ended in termination or stillbirth, but one-third of live-born infants survived to 12 months and the majority of non-survivors died within hours. This may allay concerns about prolonged and futile intensive care for parents considering a trial of therapy.
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