Neonatal survival and kidney function after prenatal interventions for obstructive uropathies

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 performed 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.

Short-term postnatal renal outcome after vesico-amniotic shunting in boys with posterior urethral valves diagnosed prenatally

“…It is worth mentioning that the early survival rate in children with prenatally suspected PUV was 21-75% with no advantage of any prenatal intervention. What is more, in our previous research VAS led to unfavourable neonatal outcomes, with a 56% 28-day survival rate [7].…”

“…Five patients were lost to follow-up. One patient was dismissed from the study after delivery due to erroneous sex determination [7]. Finally, the study group was composed of 14 boys who were observed for six months (Table 1).…”

Evaluation and Treatment of Pain in Fetuses, Neonates and Children

“…Most authors use deep general maternal anesthesia in ex-utero intrapartum therapy surgery to anesthetic the mother and the fetus and in fetoscopies the preferences are administrate the anesthesia and analgesia directly to the fetus, usually applying an intramuscular route or umbilical line [ 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”