Researchers at Children’s Hospital of Philadelphia (CHOP) reported results from a multi-site study that tested serial amnioinfusion – repeatedly adding sterile fluid into the uterus – for pregnancies with early loss of amniotic fluid caused by severe fetal kidney failure. The findings were published recently in the Journal of the American Medical Association (JAMA).
Severe congenital kidney and urinary-tract anomalies can cause little to no amniotic fluid by the second trimester, often leading to newborn mortality from underdeveloped lungs. The first report from the Renal Anhydramnios Fetal Therapy trial (RAFT) showed that serial amnioinfusion for fetuses without kidneys appeared reasonably safe and helped live-born infants avoid fatal lung underdevelopment. However, many infants later died or had serious complications, prompting early closure of that part of the study, but it continued for fetuses with kidney failure.
Co-led by Jena Lyn Miller, MD, CHOP’s Chief of Obstetrics and Gynecology, with authors Juliana Sanchez Gebb, MD, and Kristin J. McKenna, MD, MPH, the trial was conducted at 13 fetal therapy centers from December 2018 through February 2026. The study evaluated 32 pregnancies with anhydramnios identified before 22 weeks due to fetal renal failure (excluding bilateral renal agenesis), and amnioinfusions were initiated by 26 weeks per the study protocol.
Of the 32 enrolled pregnancies, 91% resulted in a live birth. Among live-born infants, 65.5% met the primary outcome – survival for at least 14 days plus placement of dialysis access – indicating some infants survived long enough to begin kidney support. Additionally, 48% survived and were discharged from the hospital at an average age of about 4.7 months, reflecting prolonged intensive care needs. Among 11 infants alive at longer-term follow-up, 64% received a kidney transplant, typically between 2 and 5 years old.
“Repeatedly replacing amniotic fluid during pregnancy may allow sufficient lung development for these newborns to survive so their kidney disease can be treated,” said Miller, who also Co-Directs CHOP’s Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment. “But it often comes with premature birth and serious long-term health challenges, so families need careful, individualized counseling. Additionally, more research is needed to reduce early delivery, standardize newborn care and improve longer-term survival and development of these infants.”
This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the NIH (R01HD100540) and the Trial Innovation Network funded by the NIH (U24TR004440).
Miller et al. “Neonatal Survival After Serial Amnioinfusions for Anhydramnios Due to Fetal Renal Failure: The RAFT Clinical Trial.” JAMA. Online July 1, 2026. DOI: 10.1001/jama.2026.8568.
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Researchers at Children’s Hospital of Philadelphia (CHOP) reported results from a multi-site study that tested serial amnioinfusion – repeatedly adding sterile fluid into the uterus – for pregnancies with early loss of amniotic fluid caused by severe fetal kidney failure. The findings were published recently in the Journal of the American Medical Association (JAMA).
Severe congenital kidney and urinary-tract anomalies can cause little to no amniotic fluid by the second trimester, often leading to newborn mortality from underdeveloped lungs. The first report from the Renal Anhydramnios Fetal Therapy trial (RAFT) showed that serial amnioinfusion for fetuses without kidneys appeared reasonably safe and helped live-born infants avoid fatal lung underdevelopment. However, many infants later died or had serious complications, prompting early closure of that part of the study, but it continued for fetuses with kidney failure.
Co-led by Jena Lyn Miller, MD, CHOP’s Chief of Obstetrics and Gynecology, with authors Juliana Sanchez Gebb, MD, and Kristin J. McKenna, MD, MPH, the trial was conducted at 13 fetal therapy centers from December 2018 through February 2026. The study evaluated 32 pregnancies with anhydramnios identified before 22 weeks due to fetal renal failure (excluding bilateral renal agenesis), and amnioinfusions were initiated by 26 weeks per the study protocol.
Of the 32 enrolled pregnancies, 91% resulted in a live birth. Among live-born infants, 65.5% met the primary outcome – survival for at least 14 days plus placement of dialysis access – indicating some infants survived long enough to begin kidney support. Additionally, 48% survived and were discharged from the hospital at an average age of about 4.7 months, reflecting prolonged intensive care needs. Among 11 infants alive at longer-term follow-up, 64% received a kidney transplant, typically between 2 and 5 years old.
“Repeatedly replacing amniotic fluid during pregnancy may allow sufficient lung development for these newborns to survive so their kidney disease can be treated,” said Miller, who also Co-Directs CHOP’s Richard D. Wood Jr. Center for Fetal Diagnosis and Treatment. “But it often comes with premature birth and serious long-term health challenges, so families need careful, individualized counseling. Additionally, more research is needed to reduce early delivery, standardize newborn care and improve longer-term survival and development of these infants.”
This research was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the NIH (R01HD100540) and the Trial Innovation Network funded by the NIH (U24TR004440).
Miller et al. “Neonatal Survival After Serial Amnioinfusions for Anhydramnios Due to Fetal Renal Failure: The RAFT Clinical Trial.” JAMA. Online July 1, 2026. DOI: 10.1001/jama.2026.8568.
Learn more here.
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