Jul 2, 2026 · 15 min · 12 segments
Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, and Preeti Malani, MD, MSJ, Deputy Editor of JAMA, the Journal of the American Medical Association, for articles published…
Kirsten Bibbins-DomingoHost
Preeti MalaniHostThe first is a study of anhydramnios from fetal kidney failure, which almost universally results in lethal pulmonary hypoplasia.
Building off the initial report of the Renal Anhydramnios Fetal Therapy, or RAF trial, published in JAMA in twenty twenty-three, this new report from Dr. Jenna Miller and colleagues uses a prospective, non-randomized clinical trial design to evaluate serial amnio infusions started from before week twenty-six gestation in thirty-two pregnant patients at thirteen US fetal therapy centers.
This RAF trial report evaluates other causes of renal failure, which collectively account for the majority of anhydramnios cases.
Among the thirty-two patients enrolled, twenty-nine pregnancies, or about ninety-one percent, resulted in live births, with a median delivery at thirty-four weeks and one day.
The primary outcome was survival to at least fourteen days with dialysis access placement.
This was achieved in nineteen of twenty-nine live born infants, or sixty-five point five percent.
Fourteen infants, or forty-eight percent of those live born, survived to hospital discharge at a median age of four point seven months, and among eleven long-term survivors to date, seven have undergone kidney transplant between two and five years.
There was no unexpected serious maternal adverse events in this study, although preterm prelabor rupture of membranes occurred in fifty-six percent of participants.
The main takeaway is that serial amnio infusions is feasible and can mitigate otherwise lethal pulmonary hypoplasia, but survivors still face major neonatal and long-term morbidity.
This intervention appears to change early survival, but it does not erase the medical complexity of prematurity, the need for dialysis, and prolonged intensive care that follow.
So nuanced family counseling is a key consideration for this therapy, which is still not widely available.
The first is a study of anhydramnios from fetal kidney failure, which almost universally results in lethal pulmonary hypoplasia.
Building off the initial report of the Renal Anhydramnios Fetal Therapy, or RAF trial, published in JAMA in twenty twenty-three, this new report from Dr. Jenna Miller and colleagues uses a prospective, non-randomized clinical trial design to evaluate serial amnio infusions started from before week twenty-six gestation in thirty-two pregnant patients at thirteen US fetal therapy centers.
This RAF trial report evaluates other causes of renal failure, which collectively account for the majority of anhydramnios cases.
Among the thirty-two patients enrolled, twenty-nine pregnancies, or about ninety-one percent, resulted in live births, with a median delivery at thirty-four weeks and one day.
The primary outcome was survival to at least fourteen days with dialysis access placement.
This was achieved in nineteen of twenty-nine live born infants, or sixty-five point five percent.
Fourteen infants, or forty-eight percent of those live born, survived to hospital discharge at a median age of four point seven months, and among eleven long-term survivors to date, seven have undergone kidney transplant between two and five years.
There was no unexpected serious maternal adverse events in this study, although preterm prelabor rupture of membranes occurred in fifty-six percent of participants.
The main takeaway is that serial amnio infusions is feasible and can mitigate otherwise lethal pulmonary hypoplasia, but survivors still face major neonatal and long-term morbidity.
This intervention appears to change early survival, but it does not erase the medical complexity of prematurity, the need for dialysis, and prolonged intensive care that follow.
So nuanced family counseling is a key consideration for this therapy, which is still not widely available.
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