Severe neonatal hydronephrosis associated with persistent pulmonary hypertension of the newborn: a multidisciplinary approach

Abstract

Introduction: severe neonatal hydronephrosis is a congenital anomaly that can lead to renal and systemic complications. Persistent pulmonary hypertension of the newborn (PPHN) is a critical condition that can worsen clinical prognosis. This case report describes the evolution of a neonate with severe hydronephrosis and PPHN, emphasizing the importance of a multidisciplinary approach.

Case Report: a full-term newborn was prenatally diagnosed with mild left renal pelvis dilation. At birth, he presented severe respiratory distress, requiring intubation and high-frequency oscillatory ventilation with inhaled nitric oxide. PPHN was diagnosed via echocardiography. Hemodynamic support and empirical antibiotic therapy were initiated. On day 4 of life, a percutaneous nephrostomy was performed, leading to progressive clinical improvement. Partial resolution of pulmonary hypertension and hemodynamic stability were documented. The patient remains under multidisciplinary follow-up by nephrology, urology, and neonatology.

Conclusions: severe neonatal hydronephrosis can be associated with PPHN, which can complicate clinical management. Early identification and appropriate surgical intervention are key to improving patient outcomes. A multidisciplinary approach optimizes clinical results and reduces long-term complications.