ESPN 54th Annual Meeting

ESPN 2022


 
Predictability factors of patient survival in case of renal oligohydramnios
MATHILDE BAUDOIN 1 CLAIRE HERBEZ-REA 1 FERDINAND DHOMBRES 1 ISABELLE GUELLEC 1 JEAN MARIE JOUANNIC 1 TIM ULINSKI 1

1- TROUSSEAU HOSPITAL - APHP.SORBONNE UNIVERSITY
 
Introduction:

 Renal oligohydramnios (ROH) is a poor prognostic factor of neonatal survival in CAKUT patients, lung hypoplasia being the main cause of mortality. We aimed to describe the foetal morbidity and mortality in case of ROH and to find predictive risk factors for morbidity which may help in antenatal counceling and post natal care.

Material and methods:

 All data were retrospectively collected at the obstretrics, neonatology and pediatric nephrology units of Trousseau hospital, from 2008 to 2020. All fetuses with renal oligohydramnios were included.

Results:

 We included 66 foetuses with renal parenchymal pathologies or posterior urethral valves (PUV) (N=25), bilateral kidney agenesis (N=10), hypodysplasia (N=16), polycystic kidney disease (N=10) causing oligamnios or anamnios, identified on antenatal ultrasound. Total mortality was 75% (50/66) including 35% antenatal deaths (22 terminations of pregnancy and 1 intrauteral death), 10 died immediately after birth, 17 died in neonatal intensive care unit and 16 survived. The presence of pneumomediastinum and pneumothorax was not different in survivors and non-survivors. The mortality in case of PUV was 52% (13/25) including 5/13 antenatal, 6/13 in ICU and 2/13 in neonatology, 3 immediately after birth. For patients with hypodysplasia 88% (14/16) have died including 3 before birth, 3 immediately after birth, and 8 in ICU. Foetuses with kidneys having features of hypodysplasia on ultrasound at T2 and those with anamnios or oligohydramnios before 32 weeks GA had a higher risk to die. There was a significant difference in plasma creatinine of the surviving patients compared to the deceased patients, from postnatal day 3 onwards (183 µmol/L [88; 255] vs. 295 µmol/L [247; 326]; p=0.038).

Conclusions:

 Pulmonary hypoplasia was not associated with an increase of neonatal mortality in this specific patient setting. However, the increase of serum creatinine (from day 3 onwards) and oligohydramnios detected before 32 weeks GA were different in survivors vs. non-survivors.