title: The anuric preterm newborn infant with a normal renal ultrasound: a diagnostic and ethical challenge.
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.
authors.affiliation: Department of Neonatology, Carmel Medical Center, The Bruce Rappaport Faculty of Medicine Technion-Israel Institute of Technology, Haifa 34362, Israel. dwaisman@netvision.net.il
authors.forename: Dan
authors.initials: D
authors.lastname: Waisman
authors.forename: Irena
authors.initials: I
authors.lastname: Kessel
authors.forename: Nathan
authors.initials: N
authors.lastname: Ish-Shalom
authors.forename: Lisa
authors.initials: L
authors.lastname: Maroun
authors.forename: Shlomit
authors.initials: S
authors.lastname: Riskin-Mashiah
authors.forename: Tzipora
authors.initials: T
authors.lastname: Falik-Zaccai
authors.forename: Zalman
authors.initials: Z
authors.lastname: Weintraub
authors.forename: Susan
authors.initials: S
authors.lastname: Albersheim
authors.forename: Avi
authors.initials: A
authors.lastname: Rotschild
mesh_terms: 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
chemical_list: D018396:Mucin-1; C043392:SERPINA1 protein, human; D000515:alpha 1-Antitrypsin