Born Without Functioning Kidneys; Navigating the Complexities of Care for Infants Born with Severe CAKUT

Friday, April 28, 2023

3:45 PM – 5:15 PM ET

Location: Convention Center: 201

CE: Live CME: 1.50

Selected By: ASPN

Chair(s)

Meredith Atkinson, MD, MHS (she/her/hers)

Associate Professor
Pediatrics
Johns Hopkins University School of Medicine
Baltimore, Maryland, United States
Cherry Mammen, MD, MHSc (he/him/his)

Clinical Assistant Professor
Pediatrics (Nephrology)
BC Children's Hospital
Vancouver, British Columbia, Canada

Disclosure(s):

Meredith Atkinson, MD, MHS: GlaxoSmithKline: Consultant (Ongoing)

Cherry Mammen, MD, MHSc: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Session

Description: The goal of this session is to introduce and discuss the complexities of caring for patients with severe congenital anomalies of the kidneys and urinary tract from prenatal diagnosis and possible intervention, through the peri-natal period, and concluding potential long-term sequelae and goals. The session will include discussion of the ethics of fetal surgical interventions for potentially fatal fetal diagnoses, as well as the ethics surrounding offering dialysis to small and premature neonates, advances in neonatal and infant dialysis, and longitudinal care of survivors of neonatal dialysis.

Topic/title: The Complexities of Prenatal Ethical Considerations for Fetuses and Infants with Severe CAKUT Diagnoses and their Caregivers

Objective: Discuss Complex ethics of offering pre-natal fetal surgical interventions and dialysis to newborns or fetuses expected to be born with kidney failure.

Topic/title: Prenatal Interventions for Fetuses with Severe CAKUT Diagnoses

Objective: Discussion of fetal surgical and medical options for fetuses with severe CAKUT diagnoses. Provide review of prenatal options for biomarker studies. Provide review of RAFT trial.

Topic/title: Advances in Acute Neonatal and Infant Dialysis

Objective: Review and discuss advances in CRRT (CarpeDiem/Aquadex versus conventional CVVHDF) and peritoneal dialysis in premature and term neonates requiring dialysis. Review of long/short term outcomes and risk for associated complications.

Topic/title: Survival, Morbidity and Mortality as a Result of (Heroic) Fetal and Neonatal Intervention

Objective: Discuss clinical, psychosocial, and societal sequelae of fetal and neonatal interventions for severe congenital anomalies of the kidneys and urinary tract. What have the last 30 years taught us?

Learning Objectives:

1. Understand ethical consideration surrounding decisions of prenatal and postnatal intervention for severe CAKUT.
2. Describe fetal surgical and medical interventions for severe CAKUT.
3. Explain benefits and risks of various forms of neonatal kidney replacement therapy for children with severe CAKUT.

Presentations:

3:45 PM – 4:05 PM ET

The Complexities of Prenatal Ethical Considerations for Fetuses and Infants with Severe CAKUT Diagnoses and their Caregivers
Speaker: DonnaMaria Cortezzo, MD – Cincinnati Children's Hospital Medical Center
4:05 PM – 4:25 PM ET

Prenatal Interventions for Fetuses with Severe CAKUT Diagnoses
Speaker: Jena MILLER, MD (she/her/hers) – Johns Hopkins University
4:25 PM – 4:45 PM ET

Advances in Acute Neonatal and Infant Dialysis
Speaker: Mahima Keswani, MD – Ann and Robert H. Lurie Childrens Hospital of Chicago; Northwestern Medicine
4:45 PM – 5:05 PM ET

Survival, Morbidity and Mortality as a Result of (Heroic) Fetal and Neonatal Intervention
Speaker: Donna J. Claes, MD, MS, BS Pharmacy (she/her/hers) – University of Cincinnati College of Medicine
5:05 PM – 5:15 PM ET

Q&A