Variation in Practice Patterns for the Management of Newborn Spina Bifida in the United States
| Autor: | Katherine J. Deans, Daryl J. McLeod, Daniel L. Lodwick, Peter C. Minneci, Lindsey Asti |
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| Rok vydání: | 2017 |
| Předmět: |
Intermittent Urethral Catheterization
medicine.medical_specialty Pediatrics Voiding cystourethrogram Urology Urinary system 030232 urology & nephrology Tertiary care Cholinergic Antagonists 03 medical and health sciences 0302 clinical medicine Clinical Protocols Surveys and Questionnaires medicine Humans In patient Practice Patterns Physicians' Spinal Dysraphism medicine.diagnostic_test Spina bifida Practice patterns business.industry Infant Newborn medicine.disease United States Pediatric urology Anti-Bacterial Agents Urodynamics Emergency medicine business 030217 neurology & neurosurgery |
| Zdroj: | Urology. 100:207-212 |
| ISSN: | 0090-4295 |
| DOI: | 10.1016/j.urology.2016.08.003 |
| Popis: | Objective To survey variations in recommended initial management of newborn spina bifida (SB). Methods Members of an international pediatric urology ListServe and of the Pediatric Urology Nurse Specialists organization were surveyed on practice patterns for newborn SB. Pediatric urologists, nurse practitioners, and physician assistants practicing in the United States were included. Results A total of 63 practitioners (48% pediatric urologists and 52% nurse practitioners or physician assistants) were included. Most practice at tertiary hospitals (94%) and about half use a protocol (56%). Recommended in-hospital screening tests include renal ultrasound (95%), voiding cystourethrogram (52%), catheterized bladder volumes (56%), and renal function tests (37%). Urodynamics are deferred until follow-up by 71%. Fifty percent of practitioners initiate clean intermittent catheterization (CIC) on all newborns, whereas 43% wait for symptoms. The majority of those who start CIC continue until residual volumes are below a threshold. Few recommend prophylactic antibiotics routinely (13%), or in patients on CIC (19%), but most recommend it for urinary reflux (62% grades 1-2, 79% grade 3, and 87% grades 4-5). Anticholinergics are deferred until after urodynamics (68%). Practicing at an institution with a pediatric urology fellowship program or an SB treatment protocol was associated with differing diagnostic work-up and urologic management. Conclusion There is variability in management of newborn SB among pediatric urology providers at tertiary care centers that may be influenced by institutional factors such as the presence of a pediatric urology fellowship or the presence of a protocol to care. This highlights the need for prospective multicenter projects to better understand how variations in management affect patient outcomes. |
| Databáze: | OpenAIRE |
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