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Mallapaty S. First fetus-to-fetus transplant demonstrated in rats. Nature 2024; 629:267-268. [PMID: 38689127 DOI: 10.1038/d41586-024-01152-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
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Lammert DB, Miller JL, Atkinson MA, Sun LR. Single-center Incidence and Patterns of Stroke in Early Renal Anhydramnios after Serial Amnioinfusions. J Pediatr 2024:114053. [PMID: 38615944 DOI: 10.1016/j.jpeds.2024.114053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/25/2024] [Accepted: 04/08/2024] [Indexed: 04/16/2024]
Abstract
The Renal Anhydramnios Fetal Therapy (RAFT) trial is a study of serial amnioinfusions to prevent lethal neonatal pulmonary hypoplasia from early renal anhydramnios. Infant neurologic outcomes were not originally evaluated. We describe the high incidence of stroke observed among infants in the treatment arm of the trial at our center.
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Affiliation(s)
- Dawn B Lammert
- Johns Hopkins School of Medicine, Department of Neurology, Division of Child Neurology, Baltimore, Maryland;.
| | - Jena L Miller
- Johns Hopkins School of Medicine, Department of Obstetrics and Gynecology, Johns Hopkins Center for Fetal Therapy, Baltimore, MD
| | - Meredith A Atkinson
- Johns Hopkins School of Medicine, Department of Pediatrics, Division of Pediatric Nephrology, Baltimore, MD
| | - Lisa R Sun
- Johns Hopkins School of Medicine, Department of Neurology, Division of Child Neurology, Baltimore, Maryland
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Bendel-Stenzel EM, Keiser AM, McKenna KJ, Chock VY, Lopez S, Miller JL, Atkinson MA. Survey of Neonatal Management After Amnioinfusion for Anhydramnios. JAMA Pediatr 2024; 178:412-414. [PMID: 38315476 PMCID: PMC10845040 DOI: 10.1001/jamapediatrics.2023.6403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 11/21/2023] [Indexed: 02/07/2024]
Abstract
This survey study reports on use of renal replacement therapy, hemodynamic support, sedation, neuroimaging, and extracorporeal membrane oxygenation at Renal Anhydramnios Fetal Therapy trial sites for neonates with either bilateral renal agenesis or fetal kidney failure.
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Affiliation(s)
- Ellen M. Bendel-Stenzel
- Pediatrics and Neonatal-Perinatal Medicine, Mayo Clinic Alix School of Medicine, Rochester, Minnesota
| | - Amaris M. Keiser
- Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kristin J. McKenna
- Clinical Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Valerie Y. Chock
- Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Suzanne Lopez
- Pediatrics, University of Texas Health Science Center at Houston, Houston
| | - Jena L. Miller
- Gynecology and Obstetrics, and Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Li O, Lee R, Boss RD, Wang MH. Palliative Care for Pediatric Urology. J Pain Symptom Manage 2024:S0885-3924(24)00676-6. [PMID: 38521421 DOI: 10.1016/j.jpainsymman.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 03/25/2024]
Abstract
Palliative care in the field of urology has largely been limited to adult oncologic conditions. Although there is a plethora of established literature suggesting the advantageous impact of palliative care, there is limited integration of palliative care in adult urology. This underutilization is further exacerbated in pediatric urology, and palliative care in pediatric urology remains an underexplored area despite the prevalence of several life-limiting conditions in this patient population. This paper highlights the potential need for palliative care intervention in a variety of urologic conditions in the pediatric population, including congenital lower urinary tract obstruction, neurogenic bladder dysfunction, exstrophy-epispadias complex, and congenital bilateral renal agenesis. Each condition poses unique challenges that can be addressed with the inclusion of a palliative care team, including decision-making spanning prenatal-neonatal-pediatric periods, acute and chronic symptom management, family relations, body image issues, risk of recurrent hospitalizations and surgeries, and potentially fatal complications. Alongside standard urologic interventions, palliative care can serve as an additional means of addressing physical and psychosocial symptoms experienced by pediatric urology patients to enhance the quality of life of patients and their families.
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Affiliation(s)
- Oscar Li
- Johns Hopkins University School of Medicine (O.L., R.L.), Baltimore, Maryland, USA.
| | - Royce Lee
- Johns Hopkins University School of Medicine (O.L., R.L.), Baltimore, Maryland, USA
| | - Renee D Boss
- Department of Pediatrics (R.D.B.), Johns Hopkins University School of Medicine, Johns Hopkins University School of Nursing, Baltimore, Maryland, USA
| | - Ming-Hsien Wang
- Jeffs Division of Pediatric Urology (M.H.W.), Charlotte Bloomberg Children's Hospital, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Hendriks S, Althaus J, Atkinson MA, Baschat AA, Berkman BE, Grady C, Wasserman D, Wendler D, Miller JL. Precarious hope: Ethical considerations for offering experimental fetal therapies outside of research after initial studies in humans. Prenat Diagn 2024; 44:180-186. [PMID: 38069681 DOI: 10.1002/pd.6474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/24/2023] [Accepted: 11/20/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE Risks and benefits of experimental fetal therapies can remain uncertain after initial clinical studies, especially long-term effects. Nevertheless, pregnant individuals may request them, hoping to benefit their future child. Guidance about offering experimental fetal therapies outside research (as "innovative therapy") is limited, despite their ethical complexity. We propose points for clinicians and reviewers to consider when deciding whether and how to offer experimental fetal therapies as innovative therapies after initial clinical studies. METHOD We used conceptual analysis and a current case to develop points for consideration, grounded in broader debates on innovative therapy and the unique challenges associated with experimental fetal therapies. RESULTS Clinicians should evaluate whether offering experimental fetal therapies as innovative therapy is appropriate for a pregnant individual and their fetus. The anticipated risk-benefit ratio for the fetus should be favorable. For the pregnant individual, risks may outweigh benefits, within reasonable limits. Medical resources should be sufficient to ensure appropriate care. Clinicians should support pregnant individuals in making informed choices. Clinicians offering innovative therapies with more than minimal risk should collect and report data on outcomes. Independent review should take place. CONCLUSION Considering these points may advance the interests of fetuses, future children, and their families.
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Affiliation(s)
- Saskia Hendriks
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - Janyne Althaus
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore, Maryland, USA
| | - Meredith A Atkinson
- Department of Pediatrics, Division of Nephrology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ahmet A Baschat
- Department of Gynecology and Obstetrics, Center for Fetal Therapy, Johns Hopkins University, Baltimore, Maryland, USA
| | - Benjamin E Berkman
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
- National Human Genome Research Institute, Bethesda, Maryland, USA
| | - Christine Grady
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - David Wasserman
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - David Wendler
- Department of Bioethics, NIH Clinical Center, Bethesda, Maryland, USA
| | - Jena L Miller
- Department of Gynecology and Obstetrics, Center for Fetal Therapy, Johns Hopkins University, Baltimore, Maryland, USA
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Kirschen GW, Blakemore K, Al-Kouatly HB, Fridkis G, Baschat A, Gearhart J, Jelin AC. The genetic etiologies of bilateral renal agenesis. Prenat Diagn 2024; 44:205-221. [PMID: 38180355 DOI: 10.1002/pd.6516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 12/14/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVE The goal of this study was to review and analyze the medical literature for cases of prenatal and/or postnatally diagnosed bilateral renal agenesis (BRA) and create a comprehensive summary of the genetic etiologies known to be associated with this condition. METHODS A literature search was conducted as a scoping review employing Online Mendeliain Inheritance in Man, PubMed, and Cochrane to identify cases of BRA with known underlying genetic (chromosomal vs. single gene) etiologies and those described in syndromes without any known genetic etiology. The cases were further categorized as isolated versus non-isolated, describing additional findings reported prenatally, postnatally, and postmortem. Inheritance pattern was also documented when appropriate in addition to the reported timing of diagnosis and sex. RESULTS We identified six cytogenetic abnormalities and 21 genes responsible for 20 single gene disorders associated with BRA. Five genes have been reported to associate with BRA without other renal anomalies; sixteen others associate with both BRA as well as unilateral renal agenesis. Six clinically recognized syndromes/associations were identified with an unknown underlying genetic etiology. Genetic etiologies of BRA are often phenotypically expressed as other urogenital anomalies as well as complex multi-system syndromes. CONCLUSION Multiple genetic etiologies of BRA have been described, including cytogenetic abnormalities and monogenic syndromes. The current era of the utilization of exome and genome-wide sequencing is likely to significantly expand our understanding of the underlying genetic architecture of BRA.
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Affiliation(s)
- Gregory W Kirschen
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Karin Blakemore
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Huda B Al-Kouatly
- Division of Maternal-Fetal Medicine, Jefferson Health, Philadelphia, New York, USA
| | - Gila Fridkis
- Physician Affiliate Group of New York, P.C. (PAGNY), Department of Pediatrics, Metropolitan Hospital Center, New York, New York, USA
| | - Ahmet Baschat
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - John Gearhart
- Department of Urology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Angie C Jelin
- Division of Maternal-Fetal Medicine, Department of Gynecology and Obstetrics, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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