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The anuric preterm newborn infant with a normal renal ultrasound: a diagnostic and ethical challenge
Author(s) -
Waisman Dan,
Kessel Irena,
IshShalom Nathan,
Maroun Lisa,
RiskinMashiah Shlomit,
FalikZaccai Tzipora,
Weintraub Zalman,
Albersheim Susan,
Rotschild Avi
Publication year - 2006
Publication title -
prenatal diagnosis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.956
H-Index - 97
eISSN - 1097-0223
pISSN - 0197-3851
DOI - 10.1002/pd.1417
Subject(s) - medicine , oligohydramnios , peritoneal dialysis , respiratory distress , overdiagnosis , intensive care medicine , pediatrics , respiratory failure , gestation , intensive care , palliative care , neonatology , pregnancy , surgery , genetics , nursing , biology
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. Copyright © 2006 John Wiley & Sons, Ltd.