Optimal Timing of Initial Postnatal Ultrasonography in Newborns With Prenatal Hydronephrosis

Abstract

No AccessJournal of UrologyMulticystic Kidney/Hydronephrosis1 Oct 2002Optimal Timing of Initial Postnatal Ultrasonography in Newborns With Prenatal Hydronephrosis John S. Wiener and Sara M. O'hara John S. WienerJohn S. Wiener More articles by this author and Sara M. O'haraSara M. O'hara More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)64423-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Conflicting data exist concerning optimal timing for initial postnatal ultrasound in newborns with prenatal hydronephrosis. To determine whether timing significantly affects the accuracy of postnatal ultrasound, we conducted a prospective study comparing ultrasound within 48 hours of birth and at 7 to 10 days of life. Materials and Methods: A total of 21 consecutive newborns with prenatal hydronephrosis were enrolled in 14 months. Prenatal hydronephrosis was defined as a pelvic diameter 4 mm. or greater before 33 weeks and 8 mm. or greater beginning at 33 weeks of gestation. Postnatal hydronephrosis was assessed using the Society for Fetal Urology grading system. Patients were subsequently followed with serial ultrasound and adjunctive imaging studies. Results: Of the 32 evaluable renal units a majority had a change in the degree of hydronephrosis between the first and second ultrasound. An increase in hydronephrosis was found in 14 (44%) renal units with an increase of 2 or greater grades in 8 (25%). At a median followup of 15 months only 3 renal units had a persistent increase in hydronephrosis. None had greater than grade 2 hydronephrosis or required therapeutic intervention. A decrease in hydronephrosis between the first and second ultrasound was noted in 8 (25%) renal units. Seven renal units were excluded from analysis due to unequivocal obstruction, and none of these demonstrated a change between the 2 sonograms. Conclusions: The degree of hydronephrosis varied between scans performed in the first 48 hours and 7 to 10 days of life in most newborns. The initial ultrasound more commonly underestimated the degree of hydronephrosis but this difference was not clinically significant at further followup. We recommend initial postnatal sonogram at 7 to 10 days of life for routine prenatal hydronephrosis but earlier scans may be appropriate in select cases. References 1 : Detection of obstructive uropathy in the fetus: predictive value of sonographic measurements of renal pelvic diameter at various gestational ages. AJR1995; 164: 719. Google Scholar 2 : Postnatal follow-up of hydronephrosis detected by prenatal ultrasound: the natural history. Fetal Diagn Ther1998; 13: 19. Crossref, Medline, Google Scholar 3 : Postpartum evaluation of fetal hydronephrosis: optimal timing for follow-up sonography. Radiology1984; 152: 423. Google Scholar 4 : The fate of infant kidneys with fetal hydronephrosis but initially normal postnatal sonography. J Urol1989; 142: 661. Link, Google Scholar 5 : Renal sonography in newborns with prenatally detected hydronephrosis: why wait?. J Urol1997; 157: 1387. Link, Google Scholar 6 : Ultrasound grading of hydronephrosis: introduction to the system used by the Society for Fetal Urology. Pediatr Radiol1993; 23: 478. Crossref, Medline, Google Scholar 7 : Evaluation of sonographic renal parenchymal area in the management of hydronephrosis. J Urol2001; 165: 548. Link, Google Scholar 8 : Diagnosis of obstructive hydronephrosis: comparison sonograms performed 6 days and 6 weeks after birth. Am J Roentgenol1995; 164: 963. Google Scholar 9 : The long-term followup of newborns with severe unilateral hydronephrosis initially treated nonoperatively. J Urol2000; 164: 1101. Link, Google Scholar From the Departments of Surgery (Division of Urologic Surgery), Pediatrics and Radiology, Duke University Medical Center, Durham, North Carolina© 2002 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 168Issue 4 Part 2October 2002Page: 1826-1829 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.Keywordsprenatal diagnosishydronephrosisultrasonographyMetricsAuthor Information John S. Wiener More articles by this author Sara M. O'hara More articles by this author Expand All Advertisement PDF downloadLoading ...