Anhydramnios due to fetal kidney failure is considered fatal for the neonate due to lethal pulmonary hypoplasia.With serial amnioinfusions delivered before the third trimester, 19 of 29 live births survived at least 14 days with dialysis access placement.Seven of the 11 infants surviving long term have received a kidney transplant.
Over a third of infants born following pregnancies with anhydramnios due to fetal kidney failure were able to avoid death from underdeveloped lungs with serial amnioinfusions during pregnancy, the nonrandomized RAFT study showed.
Twenty-nine of 32 pregnancies undergoing the intervention resulted in live births, with 19 neonates surviving at least 14 days with dialysis access placement, a result that met the study's primary endpoint, reported Meredith Atkinson, MD, MHS, of the Johns Hopkins University School of Medicine in Baltimore, and colleagues.
Seven of the 11 surviving infants to date have received a kidney transplant, as detailed in JAMA. Without the intervention to restore the amniotic fluid, the expected survival for these neonates is zero given the lethality of pulmonary hypoplasia due to fetal kidney failure.
"This study confirmed that serial amnioinfusions represent a feasible intervention that can alter the fatal prognosis of midtrimester anhydramnios by mitigating pulmonary hypoplasia in most neonates," wrote Atkinson and co-authors. "However, this path is burdened by prematurity and significant long-term morbidity, underscoring the necessity of thorough, nuanced counseling for families considering this intervention."
