Oligohydramnios
Everything in the library about oligohydramnios — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Diagnosis & Workup
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Fetal Diagnostic Imaging: Cincinnati Fetal Center
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Dr. William Polzin, Division of Maternal-Fetal Medicine, discusses fetal diagnosis imaging and predictors as well as amnioinfusions by amnioport. Dr. Ron Jaekle, University of Cincinnati Department of Obstetrics & Gynecology, proceeds Dr. P
video10:34 · Nov 2018
Medical Management
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Fetal management of advanced chronic kidney disease: Fetal Genitourinary...
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Dr. Foong-Yen Lim introduces the challenges of neonatal dialysis, the pathway of renal transplantation, and pulmonary survivor qualifications. Dr. Paul Kingma discusses the pulmonary survivor odds based upon amniotic fluid status and postna
video34:05 · Jan 2019
Long-Term Care
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Managing Advanced Chronic Kidney Disease: Cincinnati Fetal Center
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Dr. Foong-Yen Lim introduces the session topics of discussion, the challenges of neonatal dialysis, the pathway of renal transplantation, and pulmonary survivor qualifications. Dr. Paul Kingma, Neonatal Director, Cincinnati Fetal Center, di
video35:10 · Nov 2018
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Managing Advanced Chronic Kidney Disease: Cincinnati Fetal Center
If amniotic fluid levels are restored to normal through shunting or amnioinfusion, the likelihood of pulmonary survival increases to approximately 80%.
clinicalPaul Kingma2:42 ↗
If amniotic fluid levels are not returned to normal, the pulmonary outcome is poor.
clinicalPaul Kingma3:08 ↗
Many infants who are pulmonary survivors have reduced reserve lung function, similar to reduced reserve renal function, and can rapidly transition from pulmonary survivor to non-survivor if injured.
clinicalPaul Kingma5:33 ↗
Babies with renal problems who had normal amniotic fluid after replacement have developed chronic lung disease after delivery, demonstrating they are not normal from a respiratory standpoint.
clinicalPaul Kingma6:00 ↗
Any kind of urine output is much better than no urine output, even if the urine is of poor quality and does not contain cleared metabolites.
clinicalJan Scober10:32 ↗
Babies with obstructive uropathy often have a concentrating defect and produce large volumes of urine.
clinicalJan Scober11:03 ↗
Hypertension is not commonly seen in these babies because they have high urine output and are not volume overloaded, and they tend to lose sodium due to tubular dysfunction.
clinicalJan Scober15:37 ↗
Normal GFR for a newborn at 1 month of age is about 50, and it takes a whole year to reach what is accepted as normal GFR in older individuals, which is about 100.
clinicalJan Scober19:48 ↗
Reasonable predictions based on clearance and creatinine cannot be made until a patient has spent the first year of life establishing their kidney function.
clinicalJan Scober20:14 ↗
The GFR criteria in chronic kidney disease guidelines do not apply to children less than 2 years of age; these children can only be categorized as having normal, moderately reduced, or very severely reduced age-adjusted GFR.
guidelineJan Scober20:42 ↗
Dialysis is indicated when chronic kidney disease management fails, specifically when the baby stops growing (including head circumference) or when hyperkalemia or metabolic acidosis cannot be medically managed.
clinicalJan Scober22:42 ↗
Peritoneal dialysis is the technically least difficult way to provide dialysis in small children.
clinicalJan Scober23:27 ↗
Urine output remains a significant advantage because it is very difficult to manage fluid balance with dialysis alone if there is no residual diuresis.
clinicalJan Scober25:17 ↗
At this center, the size required for safe transplantation is typically between 8 and 10 kg, which usually occurs in the second year of life.
clinicalJan Scober13:24 ↗
Lower urinary tract management aims to reduce the risk of urinary tract infection through antibiotic prophylaxis and bladder irrigations, and to manage bladder pressure with anticholinergics and catheterization programs guided by urodynamic studies.
clinicalJan Scober13:53 ↗
Obstructive uropathy bladders can be very high pressure and can change over time, requiring regular follow-up and potentially changing management strategies.
clinicalJan Scober14:52 ↗
If parents want aggressive care, full respiratory support should be provided for at least the first 3 to 4 days, as many infants requiring high levels of support (including oscillator or pulmonary vasodilators) will begin to improve after this period.
clinicalPaul Kingma27:46 ↗
If the baby is not showing signs of stabilizing and improving after the first 3 to 4 days, the reality that the infant is likely not a pulmonary survivor must be discussed with parents.
clinicalPaul Kingma28:15 ↗
The question of pulmonary survival must be readdressed anytime there is an episode of lung injury, such as from sepsis.
clinicalPaul Kingma28:44 ↗
When peritoneal dialysis is not available due to peritonitis, short-term hemodialytic strategies can be attempted, though they are challenging due to the need for blood priming and large catheters in small blood vessels.
clinicalJan Scober30:04 ↗
Aquapheresis (ultrafiltration with convective clearance) using slightly smaller catheters has been successfully used to maintain an anuric baby with intraperitoneal problems.
clinicalJan Scober30:22 ↗
Temporary hemodialysis catheters in newborns are difficult to maintain because there is not much catheter design for small children, resulting in excess extravascular catheter that moves despite securing, and the 8 French catheter is limited to jugular veins.
clinicalMaria Alonso31:27 ↗
Tunneled hemodialysis catheters are easier to maintain from a movement standpoint but are still very large and likely to cause local thrombosis or stenosis in the central circulation.
clinicalMaria Alonso31:53 ↗
Nutrition in babies with urine output is easier than in oliguric or anuric babies because the formula does not need to be as concentrated.
clinicalJan Scober32:34 ↗
High-output babies lose electrolytes and may require supplementation of potassium and phosphorus, which are typically restricted in older chronic kidney disease patients.
clinicalJan Scober32:49 ↗
The density of formula is essentially an inverse function of urine output.
clinicalJan Scober33:12 ↗
The need to provide adequate protein intake may necessitate dialysis in some babies because their BUN cannot be managed otherwise.
clinicalJan Scober33:50 ↗
It is relatively unusual to expect these babies to drink spontaneously in amounts sufficient to supply adequate nutrition.
clinicalJan Scober34:15 ↗
Breast milk can be incorporated into specialized formulas that meet the baby's specific needs when mothers are motivated to provide it.
clinicalJan Scober34:31 ↗
The majority of these children have an NG tube or gastrostomy tube, which they keep even around transplant time for medication administration.
clinicalJan Scober34:45 ↗
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