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.
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Acknowledgements
We thank Dr Marcie Treadwell (Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, University of Michigan), Jeannie Kreutzman, Michigan Institute for Clinical and Health Research grant support (CTSA: UL1TR000433) for REDCap use and Corey Powell at the University of Michigan Center for Statistical Consultation and Research.
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Danziger, P., Berman, D., Luckritz, K. et al. Severe congenital anomalies of the kidney and urinary tract: epidemiology can inform ethical decision-making. J Perinatol 36, 954–959 (2016). https://doi.org/10.1038/jp.2016.107
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DOI: https://doi.org/10.1038/jp.2016.107