Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt , Nashville , Tennessee.
Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention , Atlanta , Georgia.
J Urol. 2019 Jun;201(6):1193-1198. doi: 10.1097/JU.0000000000000141.
The lifetime risk of renal damage in children with spina bifida is high but only limited baseline imaging data are available for this population. We evaluated a large prospective cohort of infants with spina bifida to define their baseline imaging characteristics.
The UMPIRE Protocol for Young Children with Spina Bifida is an iterative quality improvement protocol that follows a cohort of newborns at 9 United States centers. Using descriptive statistics, we report the initial baseline imaging characteristics, specifically regarding renal bladder ultrasound, cystogram and dimercaptosuccinic acid nuclear medicine scan.
Data on 193 infants from 2015 to 2018 were analyzed. Renal-bladder ultrasound was normal in 55.9% of infants, while 40.4% had Society for Fetal Urology grade 1 to 2 hydronephrosis in at least 1 kidney, 3.7% had grade 3 to 4 hydronephrosis in either kidney and 21.8% had grade 1 or higher bilateral hydronephrosis. There was no vesicoureteral reflux in 84.6% of infants. A third of enrolled infants underwent dimercaptosuccinic acid nuclear medicine renal scan, of whom 92.4% had no renal defects and 93.9% had a difference in differential function of less than 15%.
The majority of infants born with spina bifida have normal baseline imaging characteristics and normal urinary tract anatomy at birth. This proactive protocol offers careful scheduled surveillance of the urinary tract with the goal of lifelong maintenance of normal renal function and healthy genitourinary development.
患有脊柱裂的儿童发生肾脏损伤的终生风险很高，但针对该人群的基本影像学数据非常有限。我们评估了大量患有脊柱裂的婴儿的前瞻性队列，以确定其基本影像学特征。
UMPIRE 方案（Young Children with Spina Bifida 的统一监测和评估计划）是一项迭代质量改进方案，对 9 个美国中心的新生儿队列进行跟踪。我们使用描述性统计方法报告了初始的基本影像学特征，特别是关于肾脏-膀胱超声、膀胱造影和二巯丁二酸核医学扫描的特征。
对 2015 年至 2018 年期间的 193 名婴儿的数据进行了分析。55.9%的婴儿肾脏-膀胱超声正常，40.4%的婴儿至少有 1 侧肾脏存在胎儿泌尿外科学会分级 1 至 2 级的肾盂积水，3.7%的婴儿双侧肾脏存在分级 3 至 4 级的肾盂积水，21.8%的婴儿存在双侧肾盂积水分级 1 级或更高。84.6%的婴儿不存在膀胱输尿管反流。三分之一的入组婴儿接受了二巯丁二酸核医学肾扫描，其中 92.4%的婴儿肾脏无缺陷，93.9%的婴儿双侧肾功能差异小于 15%。
大多数出生时患有脊柱裂的婴儿具有正常的基本影像学特征和正常的泌尿道解剖结构。该主动监测方案对泌尿道进行了仔细的定期监测，旨在终生维持正常肾功能和健康的泌尿生殖发育。
