The anuric preterm newborn infant with a normal renal ultrasound: A diagnostic and ethical challenge

Dan Waisman, Irena Kessel, Nathan Ish-Shalom, Lisa Maroun, Shlomit Riskin-Mashiah, Tzipora Falik-Zaccai, Zalman Weintraub, Susan Albersheim, Avi Rotschild

Research output: Contribution to journalArticlepeer-review

5 Scopus citations

Abstract

Diagnosis and treatment of an anuric premature infant with severe respiratory compromise and a normal renal ultrasound (US), is a difficult task that requires a multidisciplinary approach. A 29-week gestation premature male infant, born after 5 weeks of worsening oligohydramnios, was ventilated for respiratory distress and remained anuric. Intensive clinical investigations and pediatric nephrology consultation that predicted very poor prognosis were followed by progressive renal failure, electrolyte imbalance, respiratory failure, ventricular arrhythmia, and finally cardiac arrest and death on day 5. In view of the predicted poor outcome, and after discussion with the parents, a decision was made not to start peritoneal dialysis (PD), and to offer only palliative therapy, with comfort care alone. Pre and postnatal diagnosis lead, in this case, to an ethical challenge that focuses on the question of futility.

Original languageEnglish
Pages (from-to)350-353
Number of pages4
JournalPrenatal Diagnosis
Volume26
Issue number4
DOIs
StatePublished - Apr 2006
Externally publishedYes

Bibliographical note

Funding Information:
The authors thank L. Columbus, D. Eisenberg, M. Phillips and M. Sawaya for helpful discussions and technical expertise. This work was supported by the NIH and the DOE-BER program. A.A.S. was supported in part by the Medical Scientist Training Program of the UCLA School of Medicine.

Keywords

  • Futility
  • Oligohydramnios
  • Peritoneal dialysis in premature newborn
  • Renal tubular dysgenesis

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