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. 2024 Aug:271:114053.
doi: 10.1016/j.jpeds.2024.114053. Epub 2024 Apr 12.

Single-Center Incidence and Patterns of Stroke in Early Renal Anhydramnios After Serial Amnioinfusions

Dawn B Lammert  1 , Jena L Miller  2 , Meredith A Atkinson  3 , Lisa R Sun  4
Affiliations

Single-Center Incidence and Patterns of Stroke in Early Renal Anhydramnios After Serial Amnioinfusions

Dawn B Lammert et al. J Pediatr. 2024 Aug.

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.

Keywords: cerebral ischemia; dysplastic kidney; renal agenesis.

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Conflict of interest statement

Declaration of Competing Interest The authors have no conflicts of interest to disclose. Funding for the Renal Anhydramnios Fetal Therapy (RAFT) Trial is provided by RO1 HD100540 from the National Institutes of Child Health and Development (NICHD; authors JLM and MAA co-PI). The NICHD had no role in the design and conduct of the study. Publication of this data was approved by the Data Safety Monitoring Board (DSMB). Renal Anhydramnios Fetal Therapy (RAFT) is listed on ClinicalTrials.gov, identifier NCT03101891. Deidentified individual participant data will not be made available.

Figures

Figure 1.
Figure 1.
Punctate stroke MRI. Participant 1: (A) Fluid-attenuated inversion recovery (FLAIR), (B) Diffusion-tensor imaging (DTI), and (C) Susceptibility weighted imaging (SWI) showing chronic microhemorrhages (arrows). Participant 4: (D) DWI (diffusion-weighted imaging) and (E) Apparent diffusion coefficient (ADC) showing diffuse cortical and bilateral internal capsule injury. (F) SWI demonstrating microhemorrhages. Participant 6: (G) DWI and (H) ADC demonstrate punctate infarcts without hemorrhagic conversion (I) SWI.
Figure 2.
Figure 2.
Quadrantal and quadrantal+ stroke MRI. DWI at four levels (top) for participants 1, 2, 3, 5, and 10 are shown. Age at stroke is indicated at the left as chronologic age (postmenstrual age). Participants 2, 3, and 10 each suffered two separate strokes.
Figure 3.
Figure 3.
Quadrantal stroke distribution is inconsistent with known major arterial distributions. Examples of typical (A) left middle cerebral artery (MCA) and (B) right posterior cerebral artery (PCA) strokes. (C) Cartoon demonstrating expected arterial distributions. (D) Quadrantal stroke spans both MCA and PCA territories.
See this image and copyright information in PMC

References

    1. Atkinson MA, Jelin EB, Baschat A, Blumenfeld YJ, Chmait RH, O’Hare E, et al. Design and Protocol of the Renal Anhydramnios Fetal Therapy (RAFT) Trial. Clin Ther. 2022;44(8):1161–71. - PMC - PubMed
    1. O’Hare EM, Jelin AC, Miller JL, Ruano R, Atkinson MA, Baschat AA, et al. Amnioinfusions to Treat Early Onset Anhydramnios Caused by Renal Anomalies: Background and Rationale for the Renal Anhydramnios Fetal Therapy Trial. Fetal Diagn Ther. 2019;45(6):365–72. - PMC - PubMed
    1. Miller JL, Baschat AA, Rosner M, Blumenfeld YJ, Moldenhauer JS, Johnson A, et al. Neonatal Survival After Serial Amnioinfusions for Bilateral Renal Agenesis: The Renal Anhydramnios Fetal Therapy Trial. JAMA. 2023;330(21):2096–105. - PMC - PubMed
    1. Felling RJ, Sun LR, Maxwell EC, Goldenberg N, Bernard T. Pediatric arterial ischemic stroke: Epidemiology, risk factors, and management. Blood Cells Mol Dis. 2017;67:23–33. - PubMed
    1. Srivastava R, Kirton A. Perinatal Stroke: A Practical Approach to Diagnosis and Management. Neoreviews. 2021;22(3):e163–e76. - PubMed

Supplementary concepts