Serial Amnioinfusions Show 65.5% Early Survival in RAFT

In a prospective, nonrandomized RAFT clinical trial published in JAMA, investigators evaluated serial amnioinfusions initiated before 26 weeks’ gestation in pregnancies with anhydramnios before 22 weeks gestation caused by fetal kidney failure other than bilateral renal agenesis. Investigators reported that the intervention mitigated lethal pulmonary hypoplasia in the treated neonates. The study was conducted at 13 US fetal therapy centers from December 2018 through February 2025, with follow-up of surviving infants through February 13, 2026.

The analysis included 32 participants who underwent serial amnioinfusions with isotonic fluid. The primary outcome was neonatal survival for at least 14 days with dialysis access placement; secondary outcomes included survival to hospital discharge and kidney transplantation.

Twenty-nine pregnancies (91%) resulted in live births, and 19 of the 29 live-born neonates (65.5%; 95% CI, 45.7%-82.1%) met the primary outcome. The median gestational age at delivery was 34 weeks 1 day, and all deliveries occurred before 37 weeks. Fourteen live-born infants (48%) survived to hospital discharge at a median age of 4.7 months.

No unexpected serious maternal adverse events occurred. The most common maternal complications were preterm prelabor rupture of membranes in 19 participants (56%) and chorioamniotic separation in 10 (29%). Among the 11 infants alive at the time of analysis, 7 (64%) had undergone kidney transplantation between ages 2 and 5 years.

The investigators reported that morbidity and mortality remained substantial beyond the early pulmonary outcome. They noted that the trial’s eligibility and specialized-center requirements limited generalizability, postnatal care was not standardized across sites, and the study did not collect long-term neurodevelopmental data. The authors concluded that the intervention could change the otherwise fatal prognosis of midtrimester anhydramnios for many neonates, while prematurity and long-term morbidity remained major burdens.

Source: Miller JL, Baschat AA, Johnson A, et al. Neonatal survival after serial amnioinfusions for anhydramnios due to fetal kidney failure: the RAFT clinical trial. JAMA. 2026;336(6):473-483. doi:10.1001/jama.2026.8568