LONG-TERM OUTCOMES OF 12 NEONATES WITH RENAL OLIGOHYDRAMNIOS TREATED WITH INTENSIVE CARE, INCLUDING KIDNEY REPLACEMENT THERAPY

 

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https://storage.unitedwebnetwork.com/files/1099/9bffaddbada3463144ace6dfd0408ef5.pdf
LONG-TERM OUTCOMES OF 12 NEONATES WITH RENAL OLIGOHYDRAMNIOS TREATED WITH INTENSIVE CARE, INCLUDING KIDNEY REPLACEMENT THERAPY

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Mariko
Sawada
Mariko Sawada mariko-sawada@hotmail.co.jp Kurashiki Central Hospital Department of Pediatrics Kurashiki Japan *
Mioka Jitsukawa mj18274@kchnet.or.jp Kurashiki Central Hospital Department of Pediatrics Kurashiki Japan -
Hiroyuki Masuda ym18273@kchnet.or.jp Kurashiki Central Hospital Department of Pediatrics Kurashiki Japan -
Eriko Iwasaki ei16998@kchnet.or.jp Kurashiki Central Hospital Department of Pediatrics Kurashiki Japan -
Kayo Ogino ko12727@kchnet.or.jp Kurashiki Central Hospital Department of Pediatrics Kurashiki Japan -
Satoshi Sunada ss16997@kchnet.or.jp Kurashiki Central Hospital Department of Pediatrics Kurashiki Japan -
Kanako Yoshizaki ky16131@kchnet.or.jp Kurashiki Central Hospital Department of Pediatrics Kurashiki Japan -
Tomohiro Hayashi th1884@kchnet.or.jp Kurashiki Central Hospital Department of Pediatrics Kurashiki Japan -
Akihito Takahashi at12605@kchnet.or.jp Kurashiki Central Hospital Department of Pediatrics Kurashiki Japan -
Kunihiko Aya ka13963@kchnet.or.jp Kurashiki Central Hospital Department of Pediatrics Kurashiki Japan -
Kenji Waki kw6169@kchnet.or.jp Kurashiki Central Hospital Department of Pediatrics Kurashiki Japan -
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Renal oligohydramnios (ROH), characterized by a marked reduction in amniotic fluid due to impaired fetal renal function, often results in severe respiratory distress and renal failure in the neonatal period. Advances in neonatal intensive care and kidney replacement therapy (KRT) have increased survival rates in recent years, but long-term outcomes remain poorly understood. This study aimed to clarify the clinical characteristics, early management, and long-term renal prognosis of neonates with ROH who received intensive care at our center.

We retrospectively reviewed 12 neonates diagnosed with ROH and treated in our neonatal intensive care unit between 2005 and 2025. Data was collected regarding underlying renal disease, perinatal course, respiratory and renal management, and long-term outcomes including renal function and survival.

The underlying renal disorders included renal hypodysplasia or dysplasia in 6 cases, polycystic kidney disease in 3 cases, urinary tract obstruction in 2 cases, and combined renal hypoplasia with cystic dysplasia in 1 case. The median gestational age at birth was 37 weeks, and the mean birth weight was 2,225 g. Prenatal amnioinfusion was performed in 2 fetuses, and 8 patients had associated congenital syndromes or malformations. All neonates required oxygen supplementation, 9 required mechanical ventilation, and 4 received inhaled nitric oxide therapy for pulmonary hypertension. Peritoneal dialysis (PD) was initiated in 3 patients at 2–37 days of age. Overall survival to discharge was achieved in 5 cases (42%). Among survivors, 1 patient subsequently underwent renal transplantation, 2 remained on chronic PD, and 1 was managed conservatively with stable renal function; 1 patient died of non-renal complications during follow-up. Mortality in the remaining 7 cases was primarily due to severe respiratory failure or multi-organ dysfunction in the early neonatal period.

Although the survival of neonates with ROH has improved through advances in intensive care and early RRT, the long-term renal prognosis remains largely dependent on the underlying renal pathology and associated anomalies. Early multidisciplinary intervention—from prenatal diagnosis and perinatal management to postnatal nephrological and respiratory support—is crucial to improving both survival and renal outcomes. Establishing a comprehensive care system that integrates fetal medicine, neonatology, and pediatric nephrology will be essential for optimizing outcomes in this high-risk population.

Kewords