Serial Amnioinfusion as Regenerative Therapy for Pulmonary Hypoplasia in Fetuses With Intrauterine Renal Failure or Severe Renal Anomalies: Systematic Review and Future Perspectives

Simrit K Warring; Victoria Novoa; Sherif Shazly; Mari Charisse Trinidad; David J Sas; Brenda Schiltz; Mikel Prieto; Andre Terzic; Rodrigo Ruano

doi:10.1016/j.mayocpiqo.2020.04.008

Serial Amnioinfusion as Regenerative Therapy for Pulmonary Hypoplasia in Fetuses With Intrauterine Renal Failure or Severe Renal Anomalies: Systematic Review and Future Perspectives

Mayo Clin Proc Innov Qual Outcomes. 2020 Aug 5;4(4):391-409. doi: 10.1016/j.mayocpiqo.2020.04.008. eCollection 2020 Aug.

Authors

Simrit K Warring¹, Victoria Novoa², Sherif Shazly¹, Mari Charisse Trinidad³, David J Sas⁴, Brenda Schiltz⁵, Mikel Prieto⁶, Andre Terzic⁷, Rodrigo Ruano³

Affiliations

¹ Department of Obstetrics & Gynecology, Mayo Clinic, Rochester, MN.
² Department of Obstetrics & Gynecology, Vanderbilt University Medical Center, Nashville, TN.
³ Division of Maternal and Fetal Medicine, Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN.
⁴ Division of Pediatric Nephrology, Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN.
⁵ Division of Pediatric Critical Care Medicine, Department of Pediatric & Adolescent Medicine, Mayo Clinic, Rochester, MN.
⁶ Department of Transplantation Surgery, Mayo Clinic, Rochester, MN.
⁷ Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN.

Abstract

The aim of this study was to investigate the effect of serial amnioinfusion therapy (SAT) for pulmonary hypoplasia in lower urinary tract obstruction (LUTO) or congenital renal anomalies (CRAs), introduce patient selection criteria, and present a case of SAT in bilateral renal agenesis. We conducted a search of the MEDLINE, EMBASE, Web of Science, and Scopus databases for articles published from database inception to November 10, 2017. Eight studies with 17 patients (7 LUTO, 8 CRA, and 2 LUTO + CRA) were included in the study. The median age of the mothers was 31 years (N=9; interquartile range [IQR], 29-33.5 years), the number of amnioinfusions was 7 (N=17; IQR, 4.5-21), gestational age at first amnioinfusion was 23 weeks and 4 days (N=17; IQR, 21-24.07), gestational age at delivery was 32 weeks and 2 days (N=17; IQR, 30 weeks to 35 weeks and 6.5 days), birthweight of newborns was 3.7 kg (N= 9; IQR, 2.7-3.7 kg), Apgar score at 1 minute was 2.5 (N=8; IQR, 1-6.5), and Apgar score at 5 minutes was 5.5 (N=8; IQR, 0-7.75). In conclusion, SAT may provide fetal pulmonary palliation by reducing the risk of newborn pulmonary compromise secondary to oligohydramnios. Multidisciplinary research efforts are required to further inform treatment and counseling guidelines. We propose a multidisciplinary approach to prenatal classification of fetuses with LUTO to inform patient selection.

Keywords: AF, amniotic fluid; AFI, AF index; AFV, AF volume; BRA, bilateral renal agenesis; CRA, congenital renal anomaly; DOL, day of life; GA, gestational age; IQR, interquartile range; LUTO, lower urinary tract obstruction; MVP, maximal vertical pocket; PD, peritoneal dialysis; PPROM, preterm premature rupture of membranes; SAT, serial amnioinfusion therapy; WHO, World Health Organization.