Utilization of Radiographic Imaging for Infant Hydronephrosis over the First 12 Months of Life

Area of Science:

• Pediatric Urology
• Radiology
• Healthcare Management

Background:

• Infant hydronephrosis (HN) management varies, potentially influenced by imaging intensity based on HN grade.
• A standardized approach to workup and surveillance is needed for optimal patient outcomes.

Purpose of the Study:

• To determine the frequency of imaging studies for infant hydronephrosis within the first year of life.
• To stratify imaging use by the initial grade of hydronephrosis in a large healthcare system.

Main Methods:

• Retrospective cohort study of infants born between 2005-2013 with confirmed hydronephrosis.
• Data collected included initial hydronephrosis grade, demographic information, and all HN-associated radiologic studies (ultrasound, VCUG, diuretic renal scans).
• Multivariate Poisson regression analyzed the association between initial HN grade and the total number of imaging studies within the first year or prior to pyeloplasty.

Main Results:

• Out of 1,380 infants, 72% had mild, 17% moderate, and 12% severe hydronephrosis.
• Infants with moderate and severe HN showed significantly higher rates of imaging use compared to those with mild HN (RR 1.57 and 2.09, respectively).
• Imaging frequency was proportional to the initial hydronephrosis grade after controlling for confounders.

Conclusions:

• Imaging utilization for infant hydronephrosis in this healthcare system is directly proportional to the initial grade of HN.
• This finding supports the use of a risk-stratified approach in managing infant hydronephrosis surveillance and workup.
• The study highlights a consistent, grade-dependent imaging strategy for pediatric hydronephrosis.