Fetal Conditions We Treat

Description of Condition:  

• Describes a group of developmental abnormalities affecting the kidneys, ureter, bladder, and/or urethra.  The ureters are the tubes that connect the kidney to the bladder. The urethra is the tube that carries urine from the bladder to outside of the body. It is one of the most common groups of abnormalities diagnosed in newborns with about 5 infants affected in every 1,000 births.

Prenatal Diagnosis and Care:   

• Often CAKUT is found during routine prenatal ultrasounds.  Your obstetrician or maternal fetal medicine physician will determine the need for additional prenatal ultrasound imaging based upon upon the location of the congenital anomaly and the amniotic fluid volumes. They may consult with neonatologists, pediatric urologists, and pediatric nephrologists to discuss neonatal care options. 

Delivery Care:  

• Delivery of your infant(s) can occur at the recommendation of your obstetrician or maternal fetal medicine physician team.  

Neonatal Care:  

• following delivery, babies with CAKUT are transferred to a neonatal intensive care unit. There, neonatologists, pediatric urologists, and pediatric nephrologists work together to assess the baby’s condition and consider next steps.  Treatment options depend on the location of the congenital anomaly, but in the early stages can potentially include surgery to address obstructions(blockages) in the urinary tract, and in some cases, dialysis. Consultation with a pediatric nephrologists can help to determine if dialysis will be needed a baby’s CAKUT condition.

Longterm Outcome:

• long term outcomes are highly variable though all children with CAKUT will have some degree of chronic kidney disease long term. CAKUT accounts for about 35% all children with kidney failure who require kidney transplantation. If kidney transplantation is needed during childhood due to kidney failure, a child would be potentially eligible for kidney transplantation once they are older than 2 years of age. 

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Description of Condition:  

• Alloimmunization is natural process of the body when it is exposed to foreign cells and tissue. “Allo” means other and refers to the fact that the immune system of the body is attacking cells and tissue that are from a different person.   
• If a mother has a negative blood type and has been exposed to a positive blood type, maybe from blood transfusion, her body will develop antibodies to the positive blood type. If she later gets pregnant and the baby has a positive blood type, the mom’s body will attack the baby’s red blood cells with the antibodies it already has to the positive blood.   
• If a mom has a negative blood type and her first baby has a positive blood type she may develop antibodies to the positive blood type. That is why we treat mom is Rhogam during pregnancy if she has a negative blood type. This will stop her body from making antibodies and protect future pregnancies.

Prenatal Diagnosis and Care:   

• • We will organize a meeting with our Maternal Fetal Medicine Team and nurse coordinator. We will discuss medical treatments that your baby may need during pregnancy, including intrauterine blood transfusions  
  • We will provide a nurse coordinator for your care.  
  • At UNC Fetal Care Center, we want to provide you with compassionate care throughout your pregnancy. We will take time to explain procedures and tests to you and work with you to develop a plan of care that serves you and your family. We have state of the art equipment and the highest trained staff in the area to meet the needs of your pregnancy. We understand that you are facing unique challenges in your pregnancy and will work to support you throughout this process.  
  • Periodic intrauterine blood transfusions can be performed throughout your pregnancy to keep the baby from becoming too anemic and prevent further complications for the baby  
  • These transfusions occur at UNC on the Labor and Delivery unit in the operating room.   
  • We will ask you not to eat or drink after midnight before the procedure  
  • We will either place an epidural or provide local anesthetic to numb the area that we will be placing the transfusion needle  
  • We will then use a long needle into the mother’s abdomen and, with ultrasound guidance, go into the baby’s umbilical cord.   
  • We will then take a sample of the umbilical cord blood to the determine the hemoglobin level and how much blood we will need to transfuse.  
  • We will then transfuse the appropriate amount of blood and retest the baby’s hemoglobin.   
  • When we are done with the procedure, we will move you to a post-operative area to monitor your baby, you will be able to eat and drink in that area. You will be discharged from Labor and Delivery within a few hours  

Delivery Care:  

• The Maternal Fetal Medicine team will work with you to determine your delivery. Usually, moms are able to deliver vaginally unless otherwise indicated. We may need to schedule your delivery date and plan for an induction or caesarian, depending on how previous babies were delivered. We will schedule your induction for 37-38 weeks gestation. If the baby is severely affected by the alloimmunization, anemic we will administer steroids to help with lung maturity and plan to deliver earlier.   

Neonatal Care:  

• • Most babies with alloimmunization will develop jaundice (yellowing of the skin). Jaundice comes from excess bilirubin, a compound released by red blood cells when they are damaged by antibodies. If left untreated, very high levels of bilirubin can cause brain damage. 
  • The initial treatment for excess bilirubin is phototherapy (therapy with a blue light). Phototherapy helps your baby get rid of bilirubin. We will monitor your baby’s bilirubin level from blood samples and start phototherapy when needed.  
  • If your baby’s bilirubin rises slowly, your baby may be able to stay with you and receive phototherapy by the Newborn Medicine team. If your baby’s bilirubin rises too quickly, your baby will be transferred to the Newborn Critical Care Center (NCCC – our NICU) for careful monitoring.  
  • In the NICU, your baby will receive phototherapy and may receive additional therapies to prevent bilirubin from getting too high. Your baby may be started on IV fluids. Your baby may also receive intravenous immunoglobulin (IVIG). IVIG prevents antibodies from damaging red blood cells and thus lowers your baby’s bilirubin level.  
  • If your baby’s bilirubin level rises to an unsafe level, your baby may require an exchange transfusion. An exchange transfusion reduces bilirubin in the body by removing blood containing harmful antibodies and replacing it with new blood. 
  • Babies that do not need an exchange transfusion may require a simple blood transfusion after birth, either in the NCCC or after discharge.  

Longterm Outcome:

• With careful monitoring and good care, most babies do very well after discharge and don’t require any special care at home.  
• The discharging care team will develop a follow-up plan with your pediatrician designed for your baby’s specific needs. This plan often involves follow-up with our pediatric hematology team who specializes in monitoring babies with this problem. 

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