The anuric preterm newborn infant with a normal renal ultrasound: a diagnostic and ethical challenge.
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.
Waisman
Dan
D
Department of Neonatology, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa 34362, Israel. dwaisman@netvision.net.il
Kessel
Irena
I
Ish-Shalom
Nathan
N
Maroun
Lisa
L
Riskin-Mashiah
Shlomit
S
Falik-Zaccai
Tzipora
T
Weintraub
Zalman
Z
Albersheim
Susan
S
Rotschild
Avi
A
D001002:Anuria / Q000175:diagnosis* / Q000209:etiology; D026690:Ethics, Clinical; D017809:Fatal Outcome; D005260:Female; D005865:Gestational Age; D006801:Humans; D006976:Hypertension, Pulmonary; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis*; D007668:Kidney / Q000000981:diagnostic imaging*; D007684:Kidney Tubules / Q000002:abnormalities* / Q000737:chemistry; D008297:Male; D018396:Mucin-1 / Q000032:analysis; D016104:Oligohydramnios / Q000000981:diagnostic imaging; D011247:Pregnancy; D011379:Prognosis; D012121:Respiration, Artificial; D012127:Respiratory Distress Syndrome, Newborn / Q000150:complications / Q000628:therapy; D014463:Ultrasonography; D000515:alpha 1-Antitrypsin / Q000032:analysis
D018396:Mucin-1; C043392:SERPINA1 protein, human; D000515:alpha 1-Antitrypsin