University Children's Hospital, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Department of Pediatrics, AK Hamburg Nord, Asklepios Medical School, Hamburg, Germany.
Pediatr Nephrol. 2018 Apr;33(4):541-545. doi: 10.1007/s00467-017-3833-y. Epub 2017 Nov 11.
The presence of renal oligohydramnios (ROH) in a fetus has been associated in the past with a poor prognosis for survival, although recent studies have shown that survival has improved considerably due to the advances in neonatology and pediatric nephrology. In an article recently published in Pediatric Nephrology, evaluation of a large series by Mehler and colleagues confirms the improved prognosis, showing a survival rate of 32 of 38 (84%). In addition, only 12 of 35 (34%) neonates required renal replacement therapy. In five of these 12 children the dialysis could be terminated after the neonatal period. This study has important implications on the decision-making process and counseling of families. While 37% of families of the study opted for termination of pregnancies, palliative care was chosen by 8% of the families, representing an important option when a decision cannot be made rapidly by affected families. A multidisciplinary approach is not only necessary in the active treatment of neonates with a history of ROH but also in antenatal counseling. In this regard future efforts should establish consensus on an ethical framework for the decision-making process in ROH.
过去，胎儿存在肾脏少尿症（ROH）与生存预后不良有关，尽管最近的研究表明，由于新生儿学和儿科肾脏病学的进步，生存率有了显著提高。在最近发表在《儿科肾脏病学》上的一篇文章中，Mehler 及其同事对大量病例的评估证实了预后的改善，显示 38 例中有 32 例（84%）存活。此外，仅 35 例中的 12 例（34%）新生儿需要肾脏替代治疗。在这 12 名儿童中，有 5 名在新生儿期后可以停止透析。这项研究对决策过程和家庭咨询具有重要意义。虽然研究中有 37%的家庭选择终止妊娠，但 8%的家庭选择姑息治疗，这是受影响家庭无法迅速做出决定时的一个重要选择。多学科方法不仅在对有 ROH 病史的新生儿进行积极治疗时是必要的，而且在产前咨询时也是必要的。在这方面，未来的努力应该就 ROH 决策过程的伦理框架达成共识。
