严重先天性肾和尿路异常：流行病学可为伦理决策提供依据。
Severe congenital anomalies of the kidney and urinary tract: epidemiology can inform ethical decision-making.
作者信息
Danziger P, Berman D R, Luckritz K, Arbour K, Laventhal N
机构信息
Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, MI, USA.
Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA.
出版信息
J Perinatol. 2016 Nov;36(11):954-959. doi: 10.1038/jp.2016.107. Epub 2016 Jul 28.
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.
目的
对于合并严重先天性肾脏和尿路畸形（CAKUT）的妊娠，决策在伦理上具有挑战性，部分原因是相关结局研究不足。
研究设计
对14年间CAKUT严重病例的回顾性队列研究。
结果
108例病例中有71例可进行全面分析。46%（n = 33）的婴儿为活产；三分之一（n = 11）存活至12个月。接受治疗试验的未存活婴儿数量是仅接受舒适护理的两倍。接受治疗试验的非存活婴儿中有三分之二在出生后9小时内死亡。活产婴儿面临气胸和新生儿透析等疾病。
结论
超过一半合并严重CAKUT的妊娠以终止妊娠或死产告终，但三分之一的活产婴儿存活至12个月，且大多数非存活婴儿在数小时内死亡。这可能会减轻那些考虑进行治疗试验的父母对长期无效重症监护的担忧。
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