Katrin Mehler1, Ingo Gottschalk2, Kathrin Burgmaier3, Ruth Volland4, Anja K Büscher5, Markus Feldkötter6, Titus Keller1, Lutz T Weber3, Angela Kribs1, Sandra Habbig7. 1. Neonatology and Pediatric Intensive Care, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany. 2. Prenatal Medicine, Department of Obstetrics and Gynecology, University Hospital of Cologne, Cologne, Germany. 3. Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany. 4. Pediatric Oncology and Hematology, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany. 5. Clinic for Pediatrics II, Pediatric Nephrology, University of Essen, Essen, Germany. 6. Pediatric Nephrology, Children's University Hospital, Bonn, Germany. 7. Pediatric Nephrology, Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany. sandra.habbig@uk-koeln.de.
Abstract
BACKGROUND: Previous studies on renal oligohydramnios (ROH) report highly variable outcome and identify early onset of ROH and presence of extrarenal manifestations as predictors of adverse outcome in most cases. Data on termination of pregnancy (TOP) and associated parental decision-making processes are mostly missing, but context-sensitive for the interpretation of these findings. We provide here a comprehensive analysis on the diagnosis, prenatal decision-making and postnatal clinical course in all pregnancies with ROH at our medical centre over an 8-year period. METHODS: We report retrospective chart review data on 103 consecutive pregnancies from 2008 to 2015 with a median follow-up of 554 days. RESULTS: After ROH diagnosis, 38 families opted for TOP. This decision was associated with onset of ROH (p < 0.001), underlying renal disease (p = 0.001) and presence of extrarenal manifestations (p = 0.02). Eight infants died in utero and 8 cases were lost to follow-up. Of the 49 liveborn children, 11 received palliative and 38 underwent active care. Overall survival of the latter group was 84.2% (n = 32) corresponding to 31% of all pregnancies (32 out of 103) analysed. One third of the surviving infants needed renal replacement therapy during the first 6 weeks of life. CONCLUSIONS: Over one third of pregnancies with ROH were terminated and the parental decision was based on risk factors associated with adverse outcome. Neonatal death was rare in the actively treated infants and the overall outcome promising. Our study illustrates that only careful analysis of the whole process, from prenatal diagnosis via parental decision-making to postnatal outcome, allows sensible interpretation of outcome data.
BACKGROUND: Previous studies on renal oligohydramnios (ROH) report highly variable outcome and identify early onset of ROH and presence of extrarenal manifestations as predictors of adverse outcome in most cases. Data on termination of pregnancy (TOP) and associated parental decision-making processes are mostly missing, but context-sensitive for the interpretation of these findings. We provide here a comprehensive analysis on the diagnosis, prenatal decision-making and postnatal clinical course in all pregnancies with ROH at our medical centre over an 8-year period. METHODS: We report retrospective chart review data on 103 consecutive pregnancies from 2008 to 2015 with a median follow-up of 554 days. RESULTS: After ROH diagnosis, 38 families opted for TOP. This decision was associated with onset of ROH (p < 0.001), underlying renal disease (p = 0.001) and presence of extrarenal manifestations (p = 0.02). Eight infants died in utero and 8 cases were lost to follow-up. Of the 49 liveborn children, 11 received palliative and 38 underwent active care. Overall survival of the latter group was 84.2% (n = 32) corresponding to 31% of all pregnancies (32 out of 103) analysed. One third of the surviving infants needed renal replacement therapy during the first 6 weeks of life. CONCLUSIONS: Over one third of pregnancies with ROH were terminated and the parental decision was based on risk factors associated with adverse outcome. Neonatal death was rare in the actively treated infants and the overall outcome promising. Our study illustrates that only careful analysis of the whole process, from prenatal diagnosis via parental decision-making to postnatal outcome, allows sensible interpretation of outcome data.
Authors: Agnes Hackl; Katrin Mehler; Ingo Gottschalk; Anne Vierzig; Marcus Eydam; Jan Hauke; Bodo B Beck; Max C Liebau; Regina Ensenauer; Lutz T Weber; Sandra Habbig Journal: Pediatr Nephrol Date: 2017-01-12 Impact factor: 3.714
Authors: E W M Grijseels; P T M Echteld van-Hornstra; L C P Govaerts; T E Cohen-Overbeek; R R de Krijger; B J Smit; K Cransberg Journal: Prenat Diagn Date: 2011-07-14 Impact factor: 3.050
Authors: Everett F Magann; Songthip Ounpraseuth; Suneet P Chauhan; Anaanth S Ranganathan; Nafisa K Dajani; Jennifer Bergstrom; John C Morrison Journal: Gynecol Obstet Invest Date: 2014-08-29 Impact factor: 2.031