Expectant use of CIC in newborns with spinal dysraphism: Report of clinical outcomes
| Autor: | Bruce J. Schlomer, Candice Walker, Richard C. Adams, Matthew D. Timberlake, Micah A. Jacobs, Adam J. Kern |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Male
Urologic Diseases Pediatrics medicine.medical_specialty Spinal dysraphism 030232 urology & nephrology Physical Therapy Sports Therapy and Rehabilitation 03 medical and health sciences 0302 clinical medicine Risk Factors medicine Humans Intermittent Urethral Catheterization Hydronephrosis Spinal Dysraphism Retrospective Studies Febrile urinary tract infection Spina bifida business.industry Rehabilitation Reflux Infant Newborn Infant Clean Intermittent Catheterization medicine.disease Treatment Outcome Dimercaptosuccinic acid 030220 oncology & carcinogenesis Child Preschool Pediatrics Perinatology and Child Health Female Abnormality business medicine.drug Follow-Up Studies |
| Zdroj: | Journal of pediatric rehabilitation medicine. 10(3-4) |
| ISSN: | 1875-8894 |
| Popis: | PURPOSE Report urologic outcomes among newborns with spinal dysraphism managed within an expectant clean intermittent catheterization (CIC) program. METHODS Newborns were followed clinically and with serial ultrasound (US). Urodynamics (UD) and dimercaptosuccinic acid (DMSA) renal scan were obtained at 3-6 months, 1 year, 3 years, then as needed. Patients with initial evaluation after 6 months were excluded. RESULTS Median follow-up was 3.2 years. 11/102 began catheterization for continence (median 4.0 years) and 47/102 did not start CIC. Of these, 2/58 developed a DMSA abnormality. 44/102 began CIC early, often for elevated storage pressures and febrile urinary tract infection (UTI). Of these, 20/44 developed a DMSA abnormality including 9 who had abnormality detected prior to starting CIC. Being on CIC or starting immediately upon recognition of new hydronephrosis, reflux, elevated filling pressures, or febrile UTI was associated with lower chance of DMSA abnormalities (4/17, 24%) compared to delaying CIC (16/27, 60%) (p= 0.03). CONCLUSIONS CIC can be deferred until continence in select infants with a low risk of significant DMSA abnormality. However, immediate initiation of CIC upon recognition of risk factors is recommended as this was associated with fewer DMSA abnormalities than delaying CIC. Recommendations for expectantly-managed patients include close follow-up, serial US and UD, and prompt initiation of CIC upon recognition of new hydronephrosis, reflux, elevated storage pressures, or febrile UTIs. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|