Prenatal Nephrology Consultations and Neonatal Dialysis Survey
Bibliographic record
Abstract
Background: Little is known about pediatric nephrology (PN) prenatal consultations for congenital anomalies of the kidney & urinary tract (CAKUT) or possible initiation of kidney replacement therapy (KRT) in neonatal end stage kidney disease (N-ESKD). The aims were to evaluate PN practice patterns for prenatal counseling of fetal CAKUT & to describe criteria used by PN to offer KRT in N-ESKD. Methods: A 35 question Qualtrics® survey was distributed via the North American Pediatric Renal Trials and Collaborative Studies email list between 1/1/2021-3/31/2021. Results: 39 of 108(36%) participating pediatric sites in the US & Canada responded. Median number of faculty (MDs, APPs, APRNS) per center was 7. Median chronic hemodialysis (HD) and peritoneal dialysis (PD) patients per center were 8 & 8, respectively. 38(97%) centers provide prenatal consultation for fetal CAKUT and KRT for N-ESKD. Of those 38 centers, 71% report only a select number of non-trainee workforce members (median 2 per center) participate in prenatal consults. 47% of centers have either written/unwritten criteria for offering KRT in N-ESKD. The most common contraindications to KRT was parental refusal(61%;Table 1). The most common birth weight contraindication was <1500g(52%). 82% of centers reported <5 neonates with ESKD were started on KRT within the past year. 58% of centers use HD therapies as a bridge to PD in N-ESKD(Figure 1); 100% of centers report PD as the primary modality at discharge.Table 1:: Reported contraindications to dialysis initiation in neonates with ESKD amongst surveyed PN centers (n=38 centers)Figure 1:: Reported use of hemodialysis/CKRT/PIRRT/modified Aquapheresis as a bridge to PD initiation in the neonate with ESKD (n=38 centers)Conclusions: Many PN programs provide prenatal consultations for CAKUT diagnoses by a select group of non-trainee workforce members. Only 50% of centers use written/unwritten criteria for decisions about KRT initiation in N-ESKD. Further multi-center research regarding prenatal consultations and neonatal KRT outcomes is necessary to provide greater evidence based practice.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".