Neonatal renal replacement therapy: An ethical reflection for a crucial decision

Archives de pédiatrie : organe officiel de la Sociéte française de pédiatrie
E LinderR Vieux

Abstract

Technological advances in fetal and neonatal medicine, recent changes in the French legal framework, and encouraging results of the long-term outcomes in children with neonatal renal failure provide elements for an ethical reflection. We led a nationwide enquiry among French pediatric nephrologists, intensivists, and neonatologists, exploring the decision-making process when contemplating starting renal replacement therapy (RRT) or delivering palliative care to neonates or infants with pre-end-stage or end-stage renal disease; and the ethical quandaries at hand in such scenarios. A total of 134 responses with complete national coverage were obtained. Care to be delivered to an infant in pre-end-stage or end-stage renal disease did not achieve consensus. Pediatric nephrologists were more prone to initiate a dialysis/graft program than pediatric intensivists. When chronic kidney disease was associated with comorbidities, especially neurological impairment, physicians, regardless of their subspecialty, were more reluctant to initiate conservative treatment. Many of the doctors surveyed did not give their opinion in these prenatal and/or postnatal situations, considered to be unique and warranting a multidisciplinary reflection. Su...Continue Reading

Citations

Aug 23, 2019·Pediatric Nephrology : Journal of the International Pediatric Nephrology Association·Aaron Wightman
Aug 5, 2020·Kidney International·Julie KleinUNKNOWN BIOMAN consortium

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