Serial Amnioinfusions Improve Survival in Fetuses With Kidney Failure–Related Anhydramnios: JAMA
Written By : Medha Baranwal
Medically Reviewed By : Dr. Kamal Kant Kohli
Published On 2026-07-16 15:00 GMT | Update On 2026-07-16 15:00 GMT
USA: A nonrandomized study has found that serial amnioinfusions performed before the third trimester helped prevent fatal pulmonary hypoplasia in some pregnancies complicated by anhydramnios due to fetal kidney failure.
Among 29 live-born infants, 19 survived for at least 14 days and underwent dialysis access placement. Of the 11 infants who achieved long-term survival, seven successfully received kidney transplants, suggesting that prenatal serial amnioinfusions may improve outcomes in this otherwise fatal condition.
Anhydramnios caused by fetal kidney failure leads to severe pulmonary hypoplasia, a condition that is usually fatal after birth. Although serial amnioinfusions have shown promise in improving lung development in fetuses with bilateral renal agenesis, their effectiveness in other causes of fetal kidney failure has remained uncertain. To investigate this, researchers conducted the Renal Anhydramnios Fetal Therapy (RAFT) Clinical Trial, published in JAMA.
The prospective, nonrandomized study was conducted at 13 US fetal therapy centers between December 2018 and February 2025. It included 32 pregnancies with anhydramnios diagnosed before 22 weeks' gestation due to fetal kidney failure, excluding bilateral renal agenesis. Participants received serial isotonic fluid amnioinfusions before 26 weeks' gestation, and surviving infants were followed through February 2026.
The study's primary endpoint was survival for at least 14 days after birth with successful placement of dialysis access. Secondary outcomes included survival to hospital discharge and receipt of a kidney transplant.
The trial revealed the following findings:
- Of the 32 enrolled pregnancies, 29 (91%) resulted in live births.
- The median gestational age at delivery was 34 weeks and 1 day, and all infants were born before 37 weeks' gestation.
- The primary outcome—survival for at least 14 days with dialysis access placement—was achieved in 19 of the 29 live-born infants (65.5%).
- Fourteen infants (48%) survived to hospital discharge after a median hospital stay of 4.7 months.
- At the latest follow-up, 11 children remained alive, and seven had undergone kidney transplantation between the ages of 2 and 5 years.
- Better neonatal survival was associated with a higher number of prenatal amnioinfusions, a longer interval between the first amnioinfusion and preterm prelabor rupture of membranes, delivery after 32 weeks' gestation, and higher birth weight.
- No unexpected serious maternal adverse events were reported during the study.
- The most common maternal complications were preterm prelabor rupture of membranes (56%) and chorioamniotic separation (29%).
The researchers concluded that prenatal serial amnioinfusions can reduce the risk of lethal pulmonary hypoplasia in fetuses with anhydramnios caused by kidney failure, allowing a substantial proportion of affected infants to survive long enough to receive life-sustaining dialysis and, in some cases, kidney transplantation. However, they emphasized that survivors continue to face considerable illness and mortality unrelated to lung development, highlighting the need for continued advances in neonatal and renal care.
Reference:
Miller JL, Baschat AA, Johnson A, et al. Neonatal Survival After Serial Amnioinfusions for Anhydramnios Due to Fetal Kidney Failure: The RAFT Clinical Trial. JAMA. Published online July 01, 2026. doi:10.1001/jama.2026.85685
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