Advancing Outcomes for Fetal Renal Failure Through Serial Amnioinfusion
Researchers from Connecticut Children’s Fetal Care Center and Fetal Care Center Dallas recently published findings in Fetal Diagnosis and Therapy that evaluated the impact of serial amnioinfusion (AI) in patients with fetal renal failure (FRF). FRF occurs when a baby is unable to produce sufficient urine to maintain normal amniotic fluid volume in the womb, which is essential for fetal lung development. As a result, many babies with FRF don’t survive after birth.
The 30 patients in this cohort were seen every Monday, Wednesday and Friday for ultrasounds to assess amniotic fluid index (AFI) and fetal wellbeing. If the AFI was below 5 cm, the patient received an amnioinfusion to maintain a stable AFI between 13–15 cm.
Key takeaways include:
- More frequent, lower volume amnioinfusions led to a lower incidence of preterm premature rupture of membranes (PPROM). Prior studies (including the RAFT trial) used fewer, larger infusions. In this study, no patient who underwent successful AIs without early PPROM (<30 weeks) died from pulmonary hypoplasia. This highlights the effectiveness of maintaining consistent amniotic fluid levels to support lung growth.
- Survival beyond the first 48 hours of life strongly correlates with survival at 6 months. A total of 83% of patients alive at 48 hours survived the neonatal period. Of those surviving the neonatal period, 62.5% to the end point of the study (6 months) with the assistance of outpatient peritoneal dialysis.
- Patients had significantly shorter durations of ventilator support, none required long-term ventilatory support or tracheostomy, and none developed bronchopulmonary dysplasia. These outcomes point to the protective benefits of this refined AI protocol.
- The protocol successfully prepared patients for kidney transplantation. Four infants underwent successful renal transplantation, and others continue to grow toward the required minimum weight of 10 kilograms for transplant eligibility.
The study demonstrates that aggressive, multidisciplinary management beginning in utero can offer patients with FRF a realistic path to long-term survival and kidney transplantation. This research marks a meaningful advancement in fetal therapy and reflects Connecticut Children’s leadership in transforming outcomes for some of the most vulnerable patients.