Moorthy I, Joshi N, Cook J V, Warren M
Guy's and St Thomas' NHS Trust, London, UK.
Clin Radiol. 2003 Dec;58(12):964-70. doi: 10.1016/s0009-9260(03)00171-5.
To determine whether normal postnatal ultrasound, as part of a strict screening protocol for the detection and follow-up of antenatal hydronephrosis, effectively excludes the majority of babies with congenital urinary tract abnormalities that would otherwise present with a urinary tract infection.
We retrospectively reviewed all babies who had postnatal follow-up of antenatally detected hydronephrosis over a 5-year period at our institution, a district general Trust with a specialist paediatric unit. We then studied all babies presenting with urinary tract infection before their first birthday to our institution over the same period. By cross-referencing these two study groups we were able to determine which babies developed a urinary tract infection having been previously discharged after normal postnatal ultrasound.
Four hundred and twenty-five babies had postnatal follow-up of antenatal hydronephrosis. Of these, 284 were investigated with ultrasound alone. In the same 5-year period, 230 babies presented with urinary tract infection before their first birthday. Only three of these babies had been previously discharged after normal postnatal ultrasound. The negative predictive value of a normal postnatal ultrasound was therefore 98.9% (281/284) for babies who subsequently presented with a urinary tract infection before their first birthday.
Careful antenatal and postnatal ultrasound with strict protocols is effective in detecting congenital renal tract abnormalities. Infants discharged after normal postnatal ultrasound are highly unlikely to still have an undetected urinary tract abnormality. We suggest that all babies with antenatal hydronephrosis are started on prophylactic antibiotics at birth, pending further investigation. All babies without features of severe obstruction antenatally should have their postnatal ultrasound delayed for a month. We recommend selective use of micturating cystourethrogram (MCUG), and delaying this investigation until the baby is 3 to 4 months old to allow for spontaneous resolution of vesicoureteric reflux. We do not believe that all babies with antenatal hydronephrosis require MCUG, providing a clear protocol is followed.
确定作为产前肾积水检测及随访严格筛查方案一部分的正常产后超声检查，是否能有效排除大多数否则会出现尿路感染的先天性尿路异常婴儿。
我们回顾性分析了在我们机构（一家设有专科儿科病房的地区综合信托医院）5年间对产前检测出肾积水进行产后随访的所有婴儿。然后我们研究了同期在我们机构1岁生日前出现尿路感染的所有婴儿。通过对这两个研究组进行交叉对照，我们能够确定哪些婴儿在产后超声检查正常后已出院，却仍发生了尿路感染。
425名婴儿接受了产前肾积水的产后随访。其中，仅接受超声检查的有284名。在同一5年期间，230名婴儿在1岁生日前出现尿路感染。这些婴儿中只有3名此前产后超声检查正常后已出院。因此，对于随后在1岁生日前出现尿路感染的婴儿，产后超声检查正常的阴性预测值为98.9%（281/284）。
采用严格方案进行仔细的产前和产后超声检查对检测先天性肾道异常有效。产后超声检查正常后出院的婴儿极不可能仍存在未被发现的尿路异常。我们建议所有产前肾积水婴儿在出生时开始预防性使用抗生素，等待进一步检查。所有产前无严重梗阻特征的婴儿应将产后超声检查推迟1个月。我们建议选择性使用排尿性膀胱尿道造影（MCUG），并将此项检查推迟至婴儿3至4个月大时进行，以便让膀胱输尿管反流自然消退。我们认为，只要遵循明确的方案，并非所有产前肾积水婴儿都需要进行MCUG检查。
