Postnatal Ultrasound Scan Research Articles

When is it necessary to perform nuclear renography in patients with a unilateral neonatal hydronephrosis?

Purpose To examine whether anteroposterior(AP) pelvic diameter on postnatal renal ultrasound scan (US) can predict both initial differential renal function (DRF) and deterioration in DRF in patients with prenatally diagnosed hydronephrosis.

Postnatal management of infants with antenatally detected hydronephrosis

With the increasing use of antenatal sonography, fetal hydronephrosis has been reported more frequently. Because of the lack of consensus regarding treatment of these infants, the postnatal approach toward fetal renal pelvis enlargement remains controversial. The aim of this prospective study is to demonstrate the postnatal investigation, treatment, and outcome of infants with prenatally diagnosed hydronephrosis. Infants whose antenatal ultrasound scan showed a fetal renal pelvis of 5 mm or greater were investigated postnatally using ultrasound (US) and voiding cystourethrography. When indicated, isotope studies and intravenous urograms were also performed. We followed prospectively neonates with antenatally diagnosed hydronephrosis and recommended management guidelines on the basis of our findings. In 156 neonates (193 kidney units) that were found to have hydronephrosis, the average gestational age at which the diagnosis was made was 32.94+/-5.10 weeks. The mean duration of postnatal follow-up was 26.3+/-13.56 months (range 3-60 months). The mean APPD of the fetal renal pelvis was 10.35+/-3.24 mm (5-9 mm in 84 kidneys, 10-14 mm in 96 kidneys and > or =15 mm in 13 kidneys). Of the 193 kidney units, 145 units were found to be pathological. The most common detected underlying abnormalities were ureteropelvic junction obstruction (in 91 kidneys; 62.7%) and vesicoureteral reflux (in 24 kidneys; 16.6%). Postnatally, 23 (45%) of 51 patients whose first US was normal were diagnosed postnatally as having urinary tract abnormality. There was a negative correlation between APPD and the rate of spontaneous resolution and positive correlation between APPD and the rate of surgery (P<0.01). In conclusion, because it is not possible to determine an upper limit of normal for the antenatal renal pelvis, any baby with AH should not be considered clinically insignificant. Infants with antenatal renal pelvis measurements > or =5 mm should be investigated postnatally. A normal postnatal ultrasound scan does not preclude the presence of urinary tract abnormality.

Randomized Clinical Trial to Assess Anal Sphincter Function After Forceps- or Vacuum-Assisted Vaginal Delivery

Fitzpatrick, Myra; Behan, Michael; O’Connell, P. Ronan; O’Herlihy , Colm Author Information

Stellenwert der postnatalen Neurosonographie für die frühzeitige Erfassung und ursächliche Klärung der Zerebralparese

Is it possible to identify patients with cerebral palsy (CP) with postnatal ultrasound scan? Which risk factors are associated with an increased risk of CP?. The data of 37 children with CP, who were sonographically investigated during the first 24 hours of life were analyzed retrospectively. The data of 21 preterm infants with gestational age </= 32 wk were compared with the data of 59 without CP. A tetraparesis was found in 15/21 of preterm babies </= 32 wk, a hemiparesis in 4/8 of premature infants >/= 33 wk and in 5/8 of the mature babies. The mature babies had prenatal brain atrophy or hypoxic-ischaemic cerebral lesions. Cytomegaly and encephalitis were detected in two babies. Immature babies >/= 33 wk showed prenatal porencephaly or encephalomalacia after asphyxia. Premature babies </= 32 wk had cystic periventricular leucomalacia (n=12) or cerebral haemorrhage (n=3); 3 babies had meningitis. Only two prematures </= 32 wk with mild CP had inconspicuous ultrasound scans. Factors associated with cerebral palsy were: cystic periventricular leucomalacia (OR 24,89; 95 % CI: 5,85 - 105,87), cerebral atrophy (OR 4,84; 95 % CI: 1,61 - 14,51), fetal hypoxia (CTG) - (OR 4,78; 95 % CI: 1,31 - 17,45), abruptio placentae (OR 4,32; 95 % CI: 1,16 - 16,13), anemia after birth (OR 18,13; 95 % CI: 1,97 - 166,43), abnormal neurological behavior at term (OR 14,00; 95 % CI: 3,29 - 59,55). Cerebral ultrasound scan after birth is a useful method detect for cerebral lesions in patients with CP-risks.

The management of prenatally diagnosed choledochal cysts

Background: Although congenital biliary tree abnormalities are uncommon in the United States, more are being diagnosed antenatally with improved imaging techniques. Methods: To determine the prognosis of prenatally diagnosed biliary disease, the authors reviewed the treatment of 3 children who had biliary cystic lesions found during routine prenatal ultrasonography. Results: All 3 children were born at term. They had elevated bilirubin levels, and postnatal ultrasound scans confirmed the presence of a biliary cystic mass. They underwent exploration within 2 weeks of life. At operation, 2 children were found to have biliary atresia with a cystic biliary lesion. They underwent Kasai procedures and are doing well at 5 and 9 months of age. The third child was found to have a type I choledochal cyst and malrotation at exploration. He underwent cystectomy with Roux-en-Y hepaticojejunostomy and a Ladd's procedure and is doing well at 3 years of age. Conclusions: Prenatally diagnosed biliary cysts represent a different spectrum of disease than those diagnosed later in life. The sequelae of biliary disease start before birth, and early operation may be necessary to achieve a good outcome. Because it is impossible to distinguish between choledochal cysts and biliary atresia on antenatal ultrasound scan or magnetic resonance imaging, children with presumed choledochal cysts should undergo early exploration to rule out potential biliary atresia. Excellent outcome is possible with early operation in the absence of severe associated anomalies. J Pediatr Surg 36:1241-1243. Copyright © 2001 by W.B. Saunders Company.

Prospective study of outcome in antenatally diagnosed renal pelvis dilatation

AIMSTo ascertain the outcome associated with antenatal renal pelvis dilatation; to recommend guidelines for postnatal investigation and determine an upper limit of normal for the anterioposterior dimensions of the fetal...

Involution rate of multicystic renal dysplasia.

To document the involution rate and long-term results of management of multicystic dysplastic kidney. Data were collected retrospectively for all 23 infants (16 boys) with multicystic dysplastic kidney who were treated at our center over the last 19 years (1977-1995). The diagnosis was based on prenatal ultrasound in 18 patients and on palpable abdominal mass in 5, and confirmed in all patients by postnatal ultrasound and radioisotope scan. Voiding cystography was performed in 18 patients to exclude vesicoureteral reflux. Mean follow-up was 46 months (range, 3 months to 5 years) and included serum creatinine measurements and renal ultrasonography. Two groups of patients were identified. Ten (43.6%) with other urologic abnormalities (group A) and 13 patients without other urologic abnormalities (group B). Vesicoureteral reflux was observed in 4 patients. Nephrectomy was performed in 4 patients, all from group B. The other 19 patients were treated conservatively. Complete involution was observed in 8 patients in group A and 6 in group B after a mean follow-up period of 9.2 and 10 months, respectively. Two patients, 1 from each group, later underwent nephrectomy not because of no involution but because of an increase in the size of the kidney involved. Patients with multicystic renal dysplasia have significant associated urologic malformations, and the natural history of the disease is unpredictable. All patients require appropriate investigation of the urinary tract and long-term follow-up. The most outstanding finding of the study is the much higher involution rate of multicystic renal dysplasia and the rate of associated urologic abnormalities than that reported in the literature. Surgery remains an option for the patients in the absence of no involution. multicystic dysplastic kidney, surgery, conservative.

Surgical treatment of vesicoureteral reflux in infants under 3 months of age

Purpose: Surgical treatment for vesicoureteral reflux (VUR) is controversial in infants, especially small infants because of technical difficulty and higher rate of spontaneous resolution. However, in some conditions, such as high-grade reflux, breakthrough infection, or severe renal scarring, early operation may be justified. This study is to evaluate the results of ureteral reimplantation in infants with VUR under 3 months of age. Methods: From January 1993 to July 1997, 13 boys and five girls (24 ureters) under 3 months of age (range, 18 days to 3 months; mean age, 2 months) received ureteral reimplantation for VUR. The initial symptoms were urinary tract infection (UTI) in 16 infants, hydronephrosis found by prenatal ultrasound scan in one, and early postnatal screening ultrasound scan in one. The indications for 24 ureter reimplantations were high-grade reflux (grade V, n = 7), breakthrough infection under medical treatment (n = 5), and severe renal scarring (n = 8) and contralateral low-grade refluxing ureters (n = 4). All patients had Glenn-Anderson's or Cohen's ureteral reimplantation. Ureteral stents were required in six ureters. All patients had renal sonogram 1 month after operation to rule out ureteral obstruction. Fifteen patients had voiding cystourethrogram (VCUG) after operation. Renal growth was evaluated in 15 patients (20 reflux renal units) using serial ultrasound or differential perfusion renal scan. The operative time, use of ureteral stent, complication rate, hospital stay, and time needed for clearing urine, were compared with those of 115 counterpart patients at age over 3 months. Data were analyzed using χ 2 test or t test. Results: All patients, except one, were free of UTI during the follow-up of 6 months to 5 years. In fifteen infants who had postoperative VCUG, 14 were free of reflux, and one had persistent lower-grade VUR. One patient had transient ureteral obstruction that resolved spontaneously. One patient had postoperative ileus for 2 weeks. Renal growth of 20 reflux renal units was similar to that of the contralateral nonreflux kidneys. The only significant difference when compared with the patients over 3 months of age, was the higher incidence of ureteral stenting (25% v 4.2%, P<.01). Conclusions: Ureteral reimplantation should be performed in infants under 3 months of age when it is indicated.

Fetal ovarian cyst decompression to prevent torsion

Background/Purpose: Neonates who have ovarian torsion caused by an ovarian cyst often lose their ovary because the torsion and infarction occurred antenatally. Because ultrasound scan has been so effective in diagnosing ovarian cysts in utero, we have a better understanding of their natural history and can select appropriate cases for cyst decompression in utero to prevent torsion. The authors reviewed experience with seven fetuses who had fetal ovarian cyst. Methods: During a 26-month period, seven patients were referred for the evaluation of fetal ovarian cyst. The mean gestational age at presentation was 31.9 ± 3.6 weeks (±SD; range, 27 to 37 weeks). There was no history of maternal risk factors such as diabetes mellitus or fetal risk factors such as hyperthyroidism or placentomegally. All seven cases involved isolated unilateral cysts without associated anomalies or chromosomal abnormalities. Mean initial cyst diameter was 3.4 ± 1.7 cm (±SD; range, 1 to 6.1). Indications used for ovarian cyst decompression included anechoic cysts with a diameter ≥4 cm, a cyst “wandering” about the abdomen on serial sonograms, or demonstrating rapid enlargement (>1 cm/wk). Results: All but one cyst progressed in size during observation. One fetal ovarian cyst (diameter, 2 cm) subsequently regressed spontaneously and another (diameter, 2.1 cm) stabilized during prenatal ultrasound surveillance. One “cyst” observed with a diameter of 3.5 cm proved to be a persistent cloaca. Four fetal ovarian cysts met criteria for decompression. Because of fetal position, decompression could not be performed in one. One cyst (seen before defining criteria for decompression) with a diameter of 5 cm was observed only and underwent torsion. Two cysts (diameters, 6.1 cm and 4 cm) were decompressed in utero under local anesthesia with ultrasound guidance, of 95 mL and 35 mL, respectively. High cyst fluid progesterone (12,041 and 1,990 ng/dL, respectively) and testosterone (1,298 and 2,900 ng/dL, respectively) confirmed the etiology of the cyst as ovarian. Neither cyst recurred, and postnatal ultrasound scan confirmed resolution. There was no maternal or fetal morbidity or mortality and only the patient observed before development of criteria for decompression lost her ovary because of torsion. Conclusions: Fetal ovarian cysts tend to present as isolated unilateral lesions in normal fetuses in the third trimester. Spontaneous regression of fetal ovarian cysts may occur. Fetal ovarian cyst decompression, in select cases, may preserve ovaries at risk for torsion.

Autoamputation of ovarian cyst in an infant

A right ovarian cyst was detected in a 34-week-gestation fetus on antenatal ultrasound scan (USS). Postnatal USS confirmed the presence of the cyst and showed it to be 4.6 cm in diameter. The cyst failed to resolve after a period of conservative management, and therefore surgical removal was performed. During the operation a free autoamputated right ovarian cyst was found. The complication had not been detected preoperatively in spite of regular USS follow-up.

Mild dilatation of the fetal kidney: a follow‐up study

To assess morbidity in children with mild prenatally detected pelvicalyceal dilatation and to document the natural history of this ultrasound finding in post-natal life. A retrospective (on-going) study was carried out in 29 children (39 kidneys) with mild dilatation confined to the pelvis and/or calices confirmed on initial post-natal ultrasound scan. Re-evaluation was carried out at a mean age of 4.2 years (range 1.5-7.8). Clinically, each patient's history, height, weight and blood pressure were recorded. On ultrasound examination the renal length, collecting system appearances and dimensions were recorded. Vesico-ureteric reflux was demonstrated in 1 of 14 infants who underwent neonatal micturating cystourethrography. During cumulative follow-up totaling 122 years, there were only two documented episodes of urological morbidity, i.e. one episode of unexplained haematuria and one of urinary tract infection. By a mean age of 4.2 years the ultrasound appearances had reverted to normal in 69% of kidneys. In 31% dilatation persisted and was unchanged or diminished in severity. No case of increasing dilatation was seen. Renal growth was normal in 97% of kidneys. Mild dilatation of the fetal urinary tract is a common prenatal ultrasound finding. When confined to the renal pelvis and/or calices it is of doubtful clinical significance and is associated with a low level of morbidity in infancy and early childhood. Invasive investigation in post-natal life is not justified.

Antenatally diagnosed urological abnormalities: where do we stand?

During a \(5{\raise0.5ex\hbox{$\scriptstyle 1$}\kern-0.1em/\kern-0.15em\lower0.25ex\hbox{$\scriptstyle 2$}}\)-year period 99 babies with antenatally diagnosed urinary tract abnormalities were referred for investigation, which revealed a total of 171 disorders. The antenatal findings were accurate in 65% of cases. Postnatal bilateral abnormalities were found in 55% of cases although bilaterality had only been noted antenatally in 31%. Referral was often delayed and in 14% the diagnosis of significant bilateral abnormality was not reached until after the 6th postnatal week. Four infants had normal postnatal ultrasound scans and yet were found later to have significant abnormalities. Another 4 had significant changes for the worse during follow-up. Inaccuracies in antenatal assessment suggest that great caution is required in counselling. Normal antenatal and postnatal sonography is not sufficient to exclude an abnormal urinary tract. The importance of early investigation and careful, continuous follow-up cannot be over-emphasised.