Neonatal Hydronephrosis: Clinical Manifestation, Diagnosis and Treatment

Abstract

Objective. To evaluate frequency, clinical manifestation, diagnostic methods, treatment and prevention of neonatal hydronephrosis at Children‘ s Hospital, Affiliate of Vilnius University Hospital Santariskių Clinic's, Neonatology Centre. Materials and methods. The retrospective analysis of medical history data of the full term newborns with congenital hydronephrosis was performed at Children‘s Hospital’s, Affiliate of Vilnius University Hospital Santariskių Klinikos, Neonatology Centre. During 2006-2011 there were 4410 newborns investigated and treated at the Full Term Newborn Department, 232 of them due to urinary tract diseases and malformations, including 83 cases of congenital hydronephrosis. Perinatal history, frequency of antenatal diagnosis, features of neonatal period, clinical signs of the disease, urological examination extent, conservative and/or surgical treatment frequency, urinary tract infection manifestation, the most common urinary tract infection pathogens and their sensitivity to antibiotics, further observation of the child and urinary tract infection preventive treatment strategy were estimated. Results. Urinary tract diseases and congenital disorders account for 5,71% out of all newborns treated at the Full Term Newborn Department of Neonatology Centre in Children‘s Hospital, Affiliate of Vilnius University Hospital Santariskių Clinic's. Among the latter congenital hydronephrosis amounts 33%, multicystic kidneys – 7,16%, vesicoureteral reflux – 12%, urinary tract infections – 38%. In 49% of cases hydronephrosis was diagnosed antenatally. Congenital hydronephrosis three times more often was diagnosed in boys. For one third of newborns congenital hydronephrosis was complicated by urinary tract infection, the most frequently identified microorganism in the urine culture was Enterococcus, susceptible for all antibiogram set antibiotics only in 5% of all the cases. Surgery was performed in 30,1% of newborns, preventive treatment of urinary tract infection was prescribed to 74,5% of the patients. Conclusions: 1. Congenital hydronephrosis – the most commonly observed and treated malformation of uropoetic system, three times more often diagnosed in boys. 2. Antenatally hydronephrosis was diagnosed in half of all the cases, at the earliest this defect was noticed in the 18th week of pregnancy. 3. On purpose to diagnose those cases of neonatal hydronephrosis that were not suspected before birth and during the first few days of life, it is appropriate to perform urinary tract ultrasound examination for all ill newborns. 4. Surgical treatment was applied to 30% of newborns, the most common cause of hydronephrosis – pyeloureteric stricture. 5. For one third of newborns congenital hydronephrosis was complicated by urinary tract infection, the most common pathogen was Enterococcus, resistant to commonly used antibiotics. It is appropriate to prescribe antibacterial treatment according to antibioticogram for the prophylaxis of newborn urinary tract infection.