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Postnatal follow-up of children having antenatal hydronephrosis  [PDF]
Milo?evi? Biljana,Stojanovi? Vesna
Medicinski Pregled , 2008, DOI: 10.2298/mpns0812596m
Abstract: The application of antenatal ultrasound for the evaluation of congenital anomalies in early pregnancy has become a common practice. Hydronephrosis is the most common anomaly observed. Antenatal interventions are experimental and done in advanced centers. Though there are defined criteria of intervention, it is still not clear as to who will benefit. Most patients will have relatively benign course, however identification of those who will have potentially serious postnatal problems permits early intervention. This study gives recommendations for the postnatal examination and follow-up of the newborns having hydronephrosis diagnosed on antenatal ultrasound.
Significance of Postnatal Follow-Up of Infants with Vesicoureteral Reflux Having Antenatal Hydronephrosis
Murat Kangin,Nejat Aksu,Onder Yavascan,Murat Anil
Iranian Journal of Pediatrics , 2010,
Abstract: Objective: To evaluate the frequency of urinary tract infections (UTIs) and degree of renal parenchymal damage as well as the parameters of growth, development and nutritional status in antenatal hydronephrosis cases with vesicoureteral reflux (VUR).Methods: Infants, whose antenatal ultrasonography (US) showed a fetal renal pelvic diameter of 5 mm or greater were investigated. Of the 277 infants with antenatal HN, 36 [56 renal units (RUs)] were diagnosed with VUR. All cases with VUR were evaluated in terms of the frequency of UTIs, scars appearing on 99mTechnetium-dimercaptosuccinic acid scan (DMSA), growth and development [height and weight standard deviation scores (HSDS and WSDS)], and nutritional status [relative weight (RW)]. Statistical evaluation was performed using the Chi-squared test.Findings: Of these 36 patients with VUR, 25 (69.4%) were males and 11 (30.6%) females. Of the 56 RUs, 48 (85.7%) had severe VUR (≥ Grade III). The mean duration of postnatal follow-up was 37.8±24.50 months. The annual UTI frequency was found to be 1.25±0.83 episodes/year. Of these 36 infants, 32 (88.8%) recovered from VUR following either medical (17 patients, 47.2%) or surgical (15 patients, 41.6%) treatment. The initial DMSA showed parenchymal defects in 16 (44.4%) RUs, and 4 RUs showed recovery in the final DMSA. Although statistically insignificant (P>0.05), initial growth and development (HSDS: -0.17±0.86; WSDS: 0.00±0.14) and nutritional status (RW: 98.19±8.81) values gradually improved (0.05±1.06, 0.06±1.071 and 101.97±14.85, respectively).Conclusion: Postnatal early diagnosis and appropriate management of VUR in infants with antenatal hydronephrosis can prevent the occurrence of frequent UTIs, renal scarring and malnutrition, enabling normal growth and development.
Antenatal and postnatal management of congenital cystic adenomatoid lung malformation diagnosed by ultrasound and Magnetic Resonance Imaging (MRI)  [PDF]
Susanne E. Gruessner, Hermann Hertel, Eva Bültmann, Charles O. A. Omwandho, Gerhard Alzen, Corinna Peter
Open Journal of Obstetrics and Gynecology (OJOG) , 2012, DOI: 10.4236/ojog.2012.24076
Abstract: Purpose: Antenatal diagnosis of congenital cystic adenomatoid lung malformation (CCAM) is vital for disease surveillance and postnatal care. Ultrasonography (US) has been the imaging gold standard for antenatal CCAM assessment. However, one of the limitations of US is the “vanishing phenomenon” caused by isoechogenicity of CCAM tissue and adjacent normal lung parenchyma. Methods: Antenatal serial US were concurrently used with magnetic resonance imaging (MRI) to monitor macro- and microcystic lesions. Results: In both pregnant women, antenatal US and MRI confirmed the presence, in the fetus, of cystic lesions and predicted disease regression/progression as well as the need for postnatal surgical intervention. Several advantages were detected by using both—serial US and MRI (over serial US alone)—including improved signal intensity, exact volume size measurements, precise CCAM location in particular for patients with adverse ultrasound conditions. Both neonates underwent surgical resection and had an uneventful post-operative course. Conclusions: Antenatal use of MRI as well as serial US improved information regarding tissue resolution and delineation of CCAM. The information from two imaging modalities was complementary. Our literature review confirmed the emerging role of prenatal MRI for postnatal monitoring and management of CCAM.
Vesicoureteral Reflux in Neonates with Hydronephrosis; Role of Imaging Tools
Hamid Mohammadjafari,Alireza Alam,Mehrnoosh Kosarian,Seyed-Abdollah Mousavi
Iranian Journal of Pediatrics , 2009,
Abstract: Objective: Neonatal Hydronephrosis is a common abnormality diagnosed ante- or postnatally. The aim of this study was to determine the prevalence and severity of vesicoureteral reflux (VUR) in neonates with antenatal or postnatal hydronephrosis and the value of ultrasonography as a noninvasive tool for VUR prediction. Methods: In a prospective study, 202 infants with neonatal hydronephrosis were studied. Two successive renal ultrasound examinations were performed at 1 and 4-6 weeks after birth in neonates with antenatal hydronephrosis or immediately after presentation. Voiding cystourethrography (VCUG) was performed in all infants. Findings: The incidence of VUR was 29.7%, of which 17.8% had severe (grade IV-V) reflux. 27% of 133 neonates with unilateral and 34.8% of 69 cases with bilateral hydronephrosis had VUR. Although a significant association was observed between severity of hydronephrosis and VUR, 5.9% of normal appearing and 7.8% of grade 1 hydronephrotic neonates had high-grade reflux. Conclusion: VUR was observed significantly in hydronephrotic neonates. A normal or mildly hydronephrotic urinary tract on ultrasound scan cannot exclude presence of severe VUR. We recommend performing VCUG in all hydronephrotic newborns.
Emilija Golubovic,Predrag Miljkovic,Sasa Zivic,Andjelka Slavkovic
Acta Medica Medianae , 2005,
Abstract: Urinary tract and renal abnormalities represent 20% of all congenital malformations.Prenatal fetal ultrasonography revealed data of echostructure of renal parenchyma, dilatation of urinary sistem and visualisation of the fetal bladder after 16 weeks of gestation.Pyelic dilatation is considered when the anteroposterior diameter exceeds 4 mm before and 7 mm after 33 th week of gestation.All the children with antenatal doubt of urinary malformation should be examined. In the last 2 years we examined 25 newborns with antenatal doubt about urinary abnormalities. Multicystic dysplastic kidney was identified in 20%, posterior urethral valves in 12%, ureterocela in 8%, vesicoureteric junction anomaly in 24%, and high grade VUR in 32%. In the secound group of newborns, which was at the same time controlled due to the postnatally revealed hydronephrosis, our annual follow-up showed that there was spontaneous reduction of changes in 50% of cases, while in 25% of cases we revealed the reflux and vesicouretheric junction anomaly in 25%.Prenatally diagnosed hydronephrosis is more severe than hydronephrosis of the same degree revealed postnatally. Hydronephrosis in the first postnatal days in sterile urine conditions has spontaneous regression in one third of examined children.
Voiding cystourethrogram in the diagnosis of vesicoureteric reflux in children with antenatally diagnosed hydronephrosis
R B Nerli,S S Amarkhed,I R Ravish
Therapeutics and Clinical Risk Management , 2008,
Abstract: R B Nerli, S S Amarkhed, I R RavishDepartment of Urology, Kles Kidney Foundation, Nehru Nagar, Belgaum, IndiaAbstract: Prenatal ultrasonography has revolutionized the detection and management of many urological abnormalities. Vesicoureteric reflux (VUR) which develops in 10% to 15% of cases of prenatal hydronephrosis, is difficult to predict prenatally. While all children with prenatal hydronephrosis should undergo ultrasonography within the first few weeks of life, there seems to be controversy regarding the role of voiding cystourethrogram (VCUG) in the assessment of these children.Materials and methods: Neonates with antenatally diagnosed unilateral hydronephrosis were prospectively assessed with sonography on day 3–7, and VCUG and isotope imaging at three months.Results: Seven (16.6%) children of the 42 children with Society of Fetal Urology grade 0/I/II hydronephrosis on postnatal sonography had evidence of VUR on VCUG. 44.4% of the refluxing ureters identified involved high grade disease and two (28.5%) children required reimplantation.Conclusions: Children with fetal reflux may be diagnosed prior to urinary tract infection and in whom further renal injury may be prevented. VCUG when performed properly is safe and presents with little risk of infectious and noninfectious complications. VCUG should be done in children in whom hydronephrosis is detected prenatally to restrict the use of VCUG to diagnose VUR. Two patients had infection.Keywords: antenatal hydronephrosis, voiding cystourethrogram, vesicoureteric reflux
Antenatal Ultrasonographic Anteroposterior Renal Pelvis Diameter Measurement: Is It a Reliable Way of Defining Fetal Hydronephrosis?  [PDF]
Alamanda Kfoury Pereira,Zilma Silveira Nogueira Reis,Maria Candida Ferrarez Bouzada,Eduardo Araújo de Oliveira,Gabriel Osanan,Ant?nio Carlos Vieira Cabral
Obstetrics and Gynecology International , 2011, DOI: 10.1155/2011/861865
Abstract: Purpose. It was to quantify the intraobserver and interobserver variability of the sonographic measurements of renal pelvis and classify hydronephrosis severity. Methods. Two ultrasonographers evaluated 17 fetuses from 23 to 39 weeks of gestation. Renal pelvis APD were taken in 50 renal units. For intraobserver error, one of them performed three sequential measurements. The mean and standard deviation from the absolute and percentage differences between measurements were calculated. Bland-Altman plots were used to visually assess the relationship between the precision of repeated measurements. Hydronephrosis was classified as mild (5.0 to 9.9?mm), moderate (10.0 to 14.9?mm), or severe (≥15.0?mm). Interrater agreement were obtained using the Kappa index. Results. Absolute intraobserver variation in APD measurements was %. Interobserver variation of ultrasonographers was %. Neither intraobserver or interobserver error increased with increasing APD size. The overall percentage of agreement with the antenatal hydronephrosis diagnosis was 64%. Cohen's Kappa to hydronephrosis severity was 0.51 (95% CI, 0.33 to 0.69). Conclusion. Inter and intraobserver APD measurement errors were low in these group, but the agreement to hydronephrosis diagnosis and classification was fair. We suggest that standard and serial APD measurement can better define and evaluate fetal hydronephrosis. 1. Introduction The advent of routine antenatal ultrasonography has allowed for an appreciation of the true incidence of urological abnormalities and has identified many patients who require reassessment postnatally [1]. In spite of such advances, however, the issue of antenatal hydronephrosis remains a common and challenging problem, with postnatal influences [2, 3]. There have been a number of studies assessing the accuracy of fetal renal pelvic dilatation (RPD) as an indicator of urinary tract anomalies [4–8]. The single most widely used parameter is the anteroposterior diameter (APD) of the renal pelvis, a simple parameter whose application is now widespread in prenatal diagnostics [9]. However, the reproducibility measurement of this parameter has scarcely been investigated. Furthermore, during routine ultrasound examinations, the size of the renal pelvis varies considerably over time [10]. Though the renal collecting system can be influenced by physiological conditions (maternal hydration and degree of bladder filling [11, 12]), the lack of a full technical description and validation of that measurement seems to be a central factor. The aim of our investigation was to evaluate the
Risk factors for antenatal depression, postnatal depression and parenting stress
Bronwyn Leigh, Jeannette Milgrom
BMC Psychiatry , 2008, DOI: 10.1186/1471-244x-8-24
Abstract: Primipara and multiparae women were recruited antenatally from two major hoitals as part of the beyondblue National Postnatal Depression Program [1]. In this subsidiary study, 367 women completed an additional large battery of validated questionnaires to identify risk factors in the antenatal period at 26–32 weeks gestation. A subsample of these women (N = 161) also completed questionnaires at 10–12 weeks postnatally. Depression level was measured by the Beck Depression Inventory (BDI).Regression analyses identified significant risk factors for the three outcome measures. (1). Significant predictors for antenatal depression: low self-esteem, antenatal anxiety, low social support, negative cognitive style, major life events, low income and history of abuse. (2). Significant predictors for postnatal depression: antenatal depression and a history of depression while also controlling for concurrent parenting stress, which was a significant variable. Antenatal depression was identified as a mediator between seven of the risk factors and postnatal depression. (3). Postnatal depression was the only significant predictor for parenting stress and also acted as a mediator for other risk factors.Risk factor profiles for antenatal depression, postnatal depression and parenting stress differ but are interrelated. Antenatal depression was the strongest predictor of postnatal depression, and in turn postnatal depression was the strongest predictor for parenting stress. These results provide clinical direction suggesting that early identification and treatment of perinatal depression is important.Depression related to child bearing can occur during pregnancy (antenatal depression), after birth (postnatal depression) or both. Antenatal and postnatal depression share similar prevalence ratings to those for depression in the general population with estimates ranging from 12–20%, with a commonly reported estimate of 13% [2-4]. The immediate and longer-term consequences of perinatal dep
Noninvasive Assessment of Antenatal Hydronephrosis in Mice Reveals a Critical Role for Robo2 in Maintaining Anti-Reflux Mechanism  [PDF]
Hang Wang, Qinggang Li, Juan Liu, Cathy Mendelsohn, David J. Salant, Weining Lu
PLOS ONE , 2011, DOI: 10.1371/journal.pone.0024763
Abstract: Antenatal hydronephrosis and vesicoureteral reflux (VUR) are common renal tract birth defects. We recently showed that disruption of the Robo2 gene is associated with VUR in humans and antenatal hydronephrosis in knockout mice. However, the natural history, causal relationship and developmental origins of these clinical conditions remain largely unclear. Although the hydronephrosis phenotype in Robo2 knockout mice has been attributed to the coexistence of ureteral reflux and obstruction in the same mice, this hypothesis has not been tested experimentally. Here we used noninvasive high-resolution micro-ultrasonography and pathological analysis to follow the progression of antenatal hydronephrosis in individual Robo2-deficient mice from embryo to adulthood. We found that hydronephrosis progressed continuously after birth with no spontaneous resolution. With the use of a microbubble ultrasound contrast agent and ultrasound-guided percutaneous aspiration, we demonstrated that antenatal hydronephrosis in Robo2-deficient mice is caused by high-grade VUR resulting from a dilated and incompetent ureterovesical junction rather than ureteral obstruction. We further documented Robo2 expression around the developing ureterovesical junction and identified early dilatation of ureteral orifice structures as a potential fetal origin of antenatal hydronephrosis and VUR. Our results thus demonstrate that Robo2 is crucial for the formation of a normal ureteral orifice and for the maintenance of an effective anti-reflux mechanism. This study also establishes a reproducible genetic mouse model of progressive antenatal hydronephrosis and primary high-grade VUR.
Antenatal and postnatal corticosteroid and resuscitation induced lung injury in preterm sheep
Noah H Hillman, J Jane Pillow, Molly K Ball, Graeme R Polglase, Suhas G Kallapur, Alan H Jobe
Respiratory Research , 2009, DOI: 10.1186/1465-9921-10-124
Abstract: To test if antenatal or postnatal corticosteroids would decrease resuscitation induced lung injury.129 d gestational age lambs (n = 5-8/gp; term = 150 d) were operatively delivered and ventilated after exposure to either 1) no medication, 2) antenatal maternal IM Betamethasone 0.5 mg/kg 24 h prior to delivery, 3) 0.5 mg/kg Dexamethasone IV at delivery or 4) Cortisol 2 mg/kg IV at delivery. Lambs then were ventilated with no PEEP and escalating tidal volumes (VT) to 15 mL/kg for 15 min and then given surfactant. The lambs were ventilated with VT 8 mL/kg and PEEP 5 cmH20 for 2 h 45 min.High VT ventilation caused a deterioration of lung physiology, lung inflammation and injury. Antenatal betamethasone improved ventilation, decreased inflammatory cytokine mRNA expression and alveolar protein leak, but did not prevent neutrophil influx. Postnatal dexamethasone decreased pro-inflammatory cytokine expression, but had no beneficial effect on ventilation, and postnatal cortisol had no effect. Ventilation increased liver serum amyloid mRNA expression, which was unaffected by corticosteroids.Antenatal betamethasone decreased lung injury without decreasing lung inflammatory cells or systemic acute phase responses. Postnatal dexamethasone or cortisol, at the doses tested, did not have important effects on lung function or injury, suggesting that corticosteroids given at birth will not decrease resuscitation mediated injury.The majority of very low birth weight infants are intubated and receive mechanical ventilation at birth [1]. A few large tidal volume breaths can inactivate surfactant [2], and initiation of ventilation with large tidal volumes activates an inflammatory cascade in the medium and small airways [3]. In surfactant deficient animals, normal tidal volume ventilation from birth initiates an inflammatory cascade characterized by inflammatory cell influx into the lungs, increased alveolar protein, inflammatory cytokine mRNA induction, and systemic acute phase inflamma
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