Division of Neonatology and Paediatric Intensive Care Medicine, Children’s Hospital, University of Cologne, Cologne, Germany.
Nephrol Dial Transplant. 2011 Nov;26(11):3514-22. doi: 10.1093/ndt/gfr046. Epub 2011 Mar 9.
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 (FiO(2), 1d), best oxygenation index (BOI, 1d) and minimum arterial partial carbon dioxide (pCO(2), 1d) at the first day of life were available in 23 children requiring intubation.
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 FiO(2) and pCO(2) (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.
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.
肾积水（ROH）主要由肾脏和尿路先天性异常（CAKUT）引起。尽管患有慢性肾衰竭的新生儿数量很少，但他们带来了许多挑战，其中最成问题的是呼吸管理和慢性肾衰竭的长期治疗。我们研究了产前和围产期变量对预测我们的 ROH 人群的生存率和总体长期预后的价值。方法：对 1996 年至 2007 年间治疗的 36 例 ROH 新生儿进行了单中心回顾性图表审查。23 例需要插管的患儿的呼吸数据集包括最小吸气氧浓度（FiO2，1d）、最佳氧合指数（BOI，1d）和出生后第一天的最小动脉部分二氧化碳（pCO2，1d）。结果：ROH 的病因是梗阻性尿路病（n=19）、多囊肾病[常染色体隐性多囊肾病（ARPKD）n=5 和常染色体显性多囊肾病 n=1]、肾发育不全/发育不良（n=10）和双侧肾静脉血栓形成（n=1）。出院时的存活率为 64%（23/36），总存活率为 58%（21/36）。7 例患儿因呼吸衰竭在 48 小时内死亡。与存活者相比，非幸存者的最低 FiO2 和 pCO2（1d）更高（P<0.001）。存活者的平均 BOI（1d）为 6.2，而未存活者为 43.9（P<0.001）。逻辑回归显示，BOI（</≥9.6）和 ROH 的首次诊断（≤/>28 孕周）在预测直至出院的存活率方面具有重要意义。结论：对开始对新生儿进行透析的态度正在发生变化，在没有严重合并症的情况下，长期预后很有希望。对患有 ROH 的胎儿进行呼吸和肾脏预后的产前预测很困难。我们的数据表明，BOI（1d）和 ROH 的发病时间可能是预测 ROH 新生儿呼吸预后的可靠指标。
