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Baseline Urinary Tract Imaging in Infants Enrolled in the UMPIRE Protocol for Children with Spina Bifida
Stacy T Tanaka1, Pangaja Paramsothy2, Judy Thibadeau2
1Division of Pediatric Urology, Monroe Carell Jr. Children's Hospital at Vanderbilt , Nashville , Tennessee.
Insights
Most infants with spina bifida have normal baseline urinary tract imaging at birth. This study provides crucial data for proactive surveillance to maintain lifelong renal function and healthy genitourinary development.
Area of Science:
- Pediatric Urology
- Medical Imaging
- Nephrology
Background:
- Children with spina bifida face a high lifetime risk of renal damage.
- Limited baseline imaging data exists for this pediatric population.
- Early identification of urinary tract abnormalities is crucial for preventing renal damage.
Purpose of the Study:
- To define the baseline imaging characteristics of infants with spina bifida.
- To evaluate a prospective cohort of newborns diagnosed with spina bifida.
- To establish imaging benchmarks for early intervention and monitoring.
Main Methods:
- Prospective cohort study of 193 infants with spina bifida across 9 US centers (2015-2018).
- Utilized the UMPIRE Protocol for Young Children with Spina Bifida.
- Collected and analyzed data from renal-bladder ultrasound, cystogram, and dimercaptosuccinic acid (DMSA) nuclear medicine scans.
Main Results:
- 55.9% of infants had normal renal-bladder ultrasounds; 40.4% showed Society for Fetal Urology (SFU) grade 1-2 hydronephrosis.
- Only 3.7% had SFU grade 3-4 hydronephrosis; 21.8% had bilateral hydronephrosis.
- 84.6% had no vesicoureteral reflux; 92.4% of DMSA scans showed no renal defects.
Conclusions:
- The majority of infants with spina bifida exhibit normal baseline urinary tract anatomy and imaging at birth.
- A proactive surveillance protocol is essential for maintaining renal function and promoting healthy genitourinary development.
- This data supports scheduled monitoring to prevent long-term renal complications.
Purpose:
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.
Materials And Methods:
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.
Results:
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%.
Conclusions:
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.
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