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Postnatal follow-up of antenatal hydronephrosis: a health-care challenge
L Cordero1, C A Nankervis, R W Oshaughnessy
1Department of Pediatrics, Division of Neonatal-Perinatal Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210-1228, USA. leandro.cordero@osumc.edu
Insights
A prenatal diagnosis program for antenatal hydronephrosis (ANH) is effective, but a high number of infants are lost to follow-up. New strategies are needed to improve postnatal care for these infants.
Area of Science:
- Pediatric Urology
- Prenatal Diagnosis
- Fetal Medicine
Background:
- Antenatal hydronephrosis (ANH) is a common fetal anomaly.
- Effective prenatal diagnosis and postnatal follow-up are crucial for managing ANH.
- Understanding follow-up success rates is vital for optimizing infant care.
Purpose of the Study:
- To evaluate the experience with ANH diagnosis at a Regional Perinatal Center.
- To determine the success rate of the established postnatal follow-up program for infants with ANH.
- To identify factors influencing postnatal follow-up compliance.
Main Methods:
- Retrospective review of maternal and infant charts from 2004-2008.
- ANH defined by anterior pelvic diameters during the third trimester (mild, moderate, severe).
- Inclusion of fetuses diagnosed with multicystic dysplastic kidney (MCDK).
Main Results:
- 268 fetuses identified with ANH; 180 (67%) required postnatal follow-up.
- Postnatal follow-up success varied: 75% for hydroureters, 68% for MCDK, and 37-58% for ANH severity.
- No common compliance barriers identified; prenatal consultation with a pediatric urologist was a positive predictor for follow-up.
Conclusions:
- The antepartum ANH diagnostic program is accessible and efficient.
- A significant number of infants were lost to follow-up, indicating an unmet need.
- Novel approaches are required to enhance postnatal follow-up for infants with ANH.
Objective:
To examine our experience with ANH and to determine the success of our postnatal follow-up program.
Study Design:
Charts of mothers and infants seen (2004 to 2008) at our Regional Perinatal Center were reviewed retrospectively. ANH was defined during the third trimester by anterior pelvic diameters as follows: mild 7 to 9, moderate 10 to 14 or severe >or=15 mm. Fetuses with multicystic dysplastic kidney (MCDK) were included.
Result:
Screening of approximately 15 000 ultrasound (US) reports identified 268 fetuses with ANH. After prenatal US surveillance, 88 (33%) fetuses had resolved, while 180 (67%) required postnatal follow-up. These 180 fetuses were diagnosed with mild 38 (21%), moderate 83 (46%) and severe 19 (11%) ANH, uni or bilateral hydroureters 12 (7%), MCDK 19 (10%) and miscellaneous 9 (5%). Postnatal follow-up was successfully established for 75% of infants with hydroureters, 68% for those with MCDK and for 37% of infants with mild, 53% with moderate and 58% with severe ANH. Factors commonly known to influence compliance were not found more frequently among the 91 infants who were lost to follow-up. The only positive predictor for postnatal follow-up was a prenatal consultation with the pediatric urologist.
Conclusion:
Our antepartum program for diagnosis of ANH is accessible and efficient; however, there was an unacceptably high number of infants lost to follow-up. The absence of traditional barriers for compliance highlights the need to explore new ways of improving postnatal follow-up of infants with ANH.
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