235 - Postnatal Management and Variation in Care Among Neonates in the RAFT Trial
Saturday, April 29, 2023
3:30 PM – 6:00 PM ET
Poster Number: 235 Publication Number: 235.243
Amaris M. Keiser, Johns Hopkins Children's Center, Baltimore, MD, United States; Ellen Bendel-Stenzel, Mayo Clinic Children's Center, Edina, MN, United States; Kristin J. McKenna, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Valerie Y. Chock, Stanford University School of Medicine, Sunnyvale, CA, United States; Suzanne Lopez, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, United States; JENA Miller, Johns Hopkins University, Elkridge, MD, United States; Meredith Atkinson, Johns Hopkins University School of Medicine, Baltimore, MD, United States
Assistant Professor, Pediatrics Johns Hopkins Children's Center Baltimore, Maryland, United States
Background: Fetal renal failure with anhydramnios due to bilateral renal agenesis or other congenital anomalies of the kidneys and urinary tract leads to lethal pulmonary hypoplasia. Prenatal amnioinfusions may improve pulmonary outcomes, but neonatal management is variable and often complicated by both prematurity and end stage kidney disease (ESKD). Objective: We report a survey of baseline neonatal management practices for infants whose mothers received serial amnioinfusions as part of the multi-center Renal Anhydramnios Fetal Therapy (RAFT) trial (NCT03101891). Design/Methods: A 46-item REDCap survey was distributed to the 9 participating RAFT sites requesting a single response per site from a neonatologist with knowledge of postnatal management strategies including the following domains: site characteristics, renal replacement therapy (RRT), hemodynamic support, sedation, neuroimaging, fluids/nutrition and ECMO utilization. Results: Response rate was 78% (7/9) but reflected sites managing 97% of neonates born to maternal participants (36/37). Choice of RRT varied, with centers using peritoneal dialysis (PD) (7), hemodialysis (HD) (5) and aquapheresis (3) alone or in combination. Minimum weight to offer RRT ranged from 1-2.5 kg and varied based on RRT modality available at each site. Initial RRT modality was HD at 5 centers and PD at 2. Although choice of inotropic hemodynamic support was similar across centers, when PD was the initial mode of RRT, volume administration for BP support was less common. Volume and hemodynamic status were assessed using serial lactates (5), arterial blood pressure (6), echocardiography (5) and near-infrared spectroscopy monitoring (2). All sites reported first-line use of morphine or fentanyl for sedation. Five centers used preterm infant guidelines for neuroimaging timing and frequency, and two used guidelines developed for RAFT patients. Daily goals for total fluid, fluid balance, and enteral feeding volume/composition varied, but all centers provide increased caloric density enteral feedings (22-30kcal/oz). ECMO is offered to RAFT patients only for reversible pulmonary hypertension or other recoverable conditions at 4 centers, and is not offered to RAFT patients at 3 centers.
Conclusion(s): We observed inter-center variation in management of neonates born to RAFT trial participants. Although harmonizing care across all sites would be challenging due to individual center expertise, there are opportunities to create practice guidelines in several domains. Developing best practices is an important step toward optimizing neonatal care in this unique patient population. Keiser_Table1_PAS2023.jpeg
