Bioethicists Call for Caution in the Use of Experimental Captive Fetal Therapy

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Citing uncertainties about the risks and benefits of an experimental therapy for fetuses whose kidneys have not developed, Johns Hopkins bioethicists and a group of medical experts have called for careful clinical trials of the use of a potential treatment, known as amnioinfusion.

the article, published prior to printing Obstruction and Gynecology, called for a better look at the ethical issues associated with this novel intervention, driven by one that has been well-informed since 2012; the child is still alive. The authors, who included including all relevant disciplines, identified 10 main categories of ethical issues related to this novel intervention: potential risks and benefits, care in clinic versus innovation versus research, counseling future parents, consent, outcome measures, access and justice, conflict of interest, impact on clinics, impact on institutions and long-term implications of society.

Bilateral renal agency occurs at 2.88 per 10,000 live births. This means that about 1,100 pregnancies are affected by this condition each year in the United States. The condition is considered equally fatal because, if the kidney does not function, the fetal lung will also not fully develop. However, serial prenatal amnioinfusions can overcome lung development problems. Treatment consists of infusion of saline solution into the amniotic sac to allow the lungs to develop. The idea is to support the fetus so that, after birth, the baby can undergo dialysis and eventually kidney transplant.

However, these infusions can also put the mother at risk and can cause premature birth. Because this intervention is still experimental, careful research needs to be done to assess the safety and effectiveness of the method. In addition, families should receive proper counseling on their options. Those facing the diagnosis of bilateral renal agenesis also have termination of pregnancy and anticipation of management with palliative care, as well as experimental interventions, to consider.

“It is important that prospective parents considering an intervention do so by enrolling in a formal clinical trial,” he said. Jeremy Sugarman, Harvey M. Meyerhoff Professor of Bioethics and Medicine at Johns Hopkins University School of Medicine and the deputy director for medicine at Berman Institute of Bioethics at The Johns Hopkins University. “In this way the decisions and experiences of families, patients and doctors can be captured so we can know if the intervention is safe and effective.”

In depth, Sugarman said, the need for long-term multicenter resistance is relevant among those who choose serial amnioinfusions and those who do not, so that physicians can identify and advise families about treatment options. and likely consequences for their fetuses.

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