Journal Article

Respiratory and general outcome in neonates with renal oligohydramnios—a single-centre experience

Katrin Mehler, Bodo B. Beck, Ingrid Kaul, Gohar Rahimi, Bernd Hoppe and Angela Kribs

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 26, issue 11, pages 3514-3522
Published in print November 2011 | ISSN: 0931-0509
Published online March 2011 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfr046
Respiratory and general outcome in neonates with renal oligohydramnios—a single-centre experience

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Background. Renal oligohydramnion (ROH) is predominantly caused by congenital abnormalities of the kidney and urogenital tract (CAKUT). Although the number of neonates born with chronic renal failure is small, they provide many challenges, and among the most problematic are respiratory management and long-term treatment of chronic renal failure. We studied the value of prenatal and perinatal variables to predict survival and the general long-term outcome of our ROH population.

Method. A single-centre retrospective chart review was conducted in 36 neonates with ROH treated between 1996 and 2007. Respiratory data sets including minimum inspiratory oxygen concentration (FiO2, 1d), best oxygenation index (BOI, 1d) and minimum arterial partial carbon dioxide (pCO2, 1d) at the first day of life were available in 23 children requiring intubation.

Results. ROH causes were obstructive uropathy (n = 19), polycystic kidney disease [autosomal recessive polycystic kidney disease (ARPKD) n = 5 and autosomal dominant polycystic kidney disease n = 1], renal agenesis/dysplasia (n = 10) and bilateral renal vein thrombosis (n = 1). Survival until discharge was 64% (23/36), and overall survival was 58% (21/36). Seven patients died within 48 h from respiratory failure. Non-survivors had a higher minimum FiO2 and pCO2 (1d) compared to survivors (P < 0.001). Mean BOI (1d) was 6.2 in survivors versus 43.9 in the non-surviving group (P < 0.001). Logistic regression showed that BOI (</≥9.6) and first diagnosis of ROH (≤/>28 gestational weeks) retained significance in predicting survival until discharge.

Conclusions. The attitude toward initiating dialysis in neonates is changing and long-term outcome in the absence of severe comorbidity is promising. Prenatal prediction concerning respiratory and renal outcome in fetuses with ROH is difficult. Our data suggest that BOI (1d) and onset of ROH may be reliable predictors of respiratory prognosis in children born with ROH.

Keywords: best oxygenation index; chronic renal failure; congenital renal failure; pulmonary hypoplasia; renal oligohydramnios

Journal Article.  4364 words.  Illustrated.

Subjects: Nephrology

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