22 年回顾性研究：胎儿肾发育不良羊水过少的长期结局，包括胎儿和新生儿预后。

Long-Term Outcomes, Including Fetal and Neonatal Prognosis, of Renal Oligohydramnios: A Retrospective Study over 22 Years.

机构信息

Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.

Division of Fetal Medicine, Center for Maternal-Fetal, Neonatal and Reproductive Medicine, National Center for Child Health and Development, Tokyo, Japan.

出版信息

J Pediatr. 2024 Oct;273:114151. doi: 10.1016/j.jpeds.2024.114151. Epub 2024 Jun 15.

DOI:10.1016/j.jpeds.2024.114151

PMID:38880380

Abstract

OBJECTIVE

To assess the long-term outcome of renal oligohydramnios and risk factors for fetal, neonatal, and postneonatal death.

STUDY DESIGN

This retrospective cohort study included fetuses with prenatally detected renal oligohydramnios between 2002 and 2023. Patients who were lost to follow-up were excluded. Fetal, neonatal, and long-term outcomes were evaluated, and their risk factors were analyzed.

RESULTS

Of 131 fetuses with renal oligohydramnios, 46 (35%) underwent a termination of pregnancy, 11 (8%) had an intrauterine fetal death, 26 (20%) had a neonatal death, nine (7%) had a postneonatal death, and 39 (30%) survived. Logistic regression analyses showed that an earlier gestational age at onset (OR 1.16, 95% CI 1.01-1.37) was significantly associated with intrauterine fetal death; anhydramnios (OR 12.7, 95% CI 1.52-106.7) was significantly associated with neonatal death as a prenatal factor. Although neonatal survival rates for bilateral renal agenesis, bilateral multicystic dysplastic kidney (MCDK), and unilateral MCDK with contralateral renal agenesis were lower than for other kidney diseases, 1 case of bilateral renal agenesis and two of bilateral MCDK survived with fetal intervention. Kaplan-Meier overall survival rates were 57%, 55%, and 51% for 1, 3, and 5 years, respectively. In the Cox proportional hazards model, birth weight <2000 g (hazard ratio 7.33, 95% CI 1.48-36.1) and gastrointestinal comorbidity (hazard ratio 4.37, 95% CI 1.03-18.5) were significant risk factors for postneonatal death.

CONCLUSION

Long-term survival following renal oligohydramnios is a feasible goal and its appropriate risk assessment is important.

摘要

目的

评估胎儿、新生儿和围生期死亡的肾羊水过少的长期结局及其危险因素。

研究设计

本回顾性队列研究纳入了 2002 年至 2023 年间产前诊断为肾羊水过少的胎儿。排除失访患者。评估胎儿、新生儿和长期结局，并分析其危险因素。

结果

在 131 例肾羊水过少的胎儿中，46 例（35%）行终止妊娠，11 例（8%）发生宫内胎儿死亡，26 例（20%）发生新生儿死亡，9 例（7%）发生围生期后死亡，39 例（30%）存活。Logistic 回归分析显示，发病时的胎龄较早（OR 1.16，95%CI 1.01-1.37）与宫内胎儿死亡显著相关；无羊水（OR 12.7，95%CI 1.52-106.7）与产前因素新生儿死亡显著相关。尽管双侧肾发育不全、双侧多囊性发育不良肾（MCDK）和单侧 MCDK 伴对侧肾发育不全的新生儿存活率低于其他肾脏疾病，但 1 例双侧肾发育不全和 2 例双侧 MCDK 经胎儿干预后存活。Kaplan-Meier 总体生存率分别为 1、3 和 5 年时的 57%、55%和 51%。在 Cox 比例风险模型中，出生体重<2000 g（风险比 7.33，95%CI 1.48-36.1）和胃肠道合并症（风险比 4.37，95%CI 1.03-18.5）是围生期后死亡的显著危险因素。