Expectant use of CIC in newborns with spinal dysraphism: Report of clinical outcomes

Matthew D. Timberlake, Adam J. Kern, Richard Adams, Candice Walker, Bruce J. Schlomer, Micah A. Jacobs

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

PURPOSE: Report urologic outcomes among newborns with spinal dysraphism managed within an expectant clean intermittent catheterization (CIC) program. METHODS: Newborns were followed clinically and with serial ultrasound (US). Urodynamics (UD) and dimercaptosuccinic acid (DMSA) renal scan were obtained at 3-6 months, 1 year, 3 years, then as needed. Patients with initial evaluation after 6 months were excluded. RESULTS: Median follow-up was 3.2 years. 11/102 began catheterization for continence (median 4.0 years) and 47/102 did not start CIC. Of these, 2/58 developed a DMSA abnormality. 44/102 began CIC early, often for elevated storage pressures and febrile urinary tract infection (UTI). Of these, 20/44 developed a DMSA abnormality including 9 who had abnormality detected prior to starting CIC. Being on CIC or starting immediately upon recognition of new hydronephrosis, reflux, elevated filling pressures, or febrile UTI was associated with lower chance of DMSA abnormalities (4/17, 24%) compared to delaying CIC (16/27, 60%) (p= 0.03). CONCLUSIONS: CIC can be deferred until continence in select infants with a low risk of significant DMSA abnormality. However, immediate initiation of CIC upon recognition of risk factors is recommended as this was associated with fewer DMSA abnormalities than delaying CIC. Recommendations for expectantly-managed patients include close follow-up, serial US and UD, and prompt initiation of CIC upon recognition of new hydronephrosis, reflux, elevated storage pressures, or febrile UTIs.

Original languageEnglish (US)
Pages (from-to)319-325
Number of pages7
JournalJournal of Pediatric Rehabilitation Medicine
Volume10
Issue number3-4
DOIs
StatePublished - Jan 1 2017

Fingerprint

Intermittent Urethral Catheterization
Spinal Dysraphism
Succimer
Newborn Infant
Fever
Hydronephrosis
Urodynamics
Pressure
Urinary Tract Infections
Catheterization

Keywords

  • Clean intermittent catheterization
  • DMSA abnormalities
  • Expectant management
  • Newborn management
  • Renal outcomes urinary tract infection
  • Spina bifida
  • Spinal dysraphism
  • Urodynamics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Physical Therapy, Sports Therapy and Rehabilitation
  • Rehabilitation

Cite this

Expectant use of CIC in newborns with spinal dysraphism : Report of clinical outcomes. / Timberlake, Matthew D.; Kern, Adam J.; Adams, Richard; Walker, Candice; Schlomer, Bruce J.; Jacobs, Micah A.

In: Journal of Pediatric Rehabilitation Medicine, Vol. 10, No. 3-4, 01.01.2017, p. 319-325.

Research output: Contribution to journalArticle

@article{1f596be7aa294c6b8abf16cfe35ac0ef,
title = "Expectant use of CIC in newborns with spinal dysraphism: Report of clinical outcomes",
abstract = "PURPOSE: Report urologic outcomes among newborns with spinal dysraphism managed within an expectant clean intermittent catheterization (CIC) program. METHODS: Newborns were followed clinically and with serial ultrasound (US). Urodynamics (UD) and dimercaptosuccinic acid (DMSA) renal scan were obtained at 3-6 months, 1 year, 3 years, then as needed. Patients with initial evaluation after 6 months were excluded. RESULTS: Median follow-up was 3.2 years. 11/102 began catheterization for continence (median 4.0 years) and 47/102 did not start CIC. Of these, 2/58 developed a DMSA abnormality. 44/102 began CIC early, often for elevated storage pressures and febrile urinary tract infection (UTI). Of these, 20/44 developed a DMSA abnormality including 9 who had abnormality detected prior to starting CIC. Being on CIC or starting immediately upon recognition of new hydronephrosis, reflux, elevated filling pressures, or febrile UTI was associated with lower chance of DMSA abnormalities (4/17, 24{\%}) compared to delaying CIC (16/27, 60{\%}) (p= 0.03). CONCLUSIONS: CIC can be deferred until continence in select infants with a low risk of significant DMSA abnormality. However, immediate initiation of CIC upon recognition of risk factors is recommended as this was associated with fewer DMSA abnormalities than delaying CIC. Recommendations for expectantly-managed patients include close follow-up, serial US and UD, and prompt initiation of CIC upon recognition of new hydronephrosis, reflux, elevated storage pressures, or febrile UTIs.",
keywords = "Clean intermittent catheterization, DMSA abnormalities, Expectant management, Newborn management, Renal outcomes urinary tract infection, Spina bifida, Spinal dysraphism, Urodynamics",
author = "Timberlake, {Matthew D.} and Kern, {Adam J.} and Richard Adams and Candice Walker and Schlomer, {Bruce J.} and Jacobs, {Micah A.}",
year = "2017",
month = "1",
day = "1",
doi = "10.3233/PRM-170464",
language = "English (US)",
volume = "10",
pages = "319--325",
journal = "Journal of Pediatric Rehabilitation Medicine",
issn = "1874-5393",
publisher = "IOS Press",
number = "3-4",

}

TY - JOUR

T1 - Expectant use of CIC in newborns with spinal dysraphism

T2 - Report of clinical outcomes

AU - Timberlake, Matthew D.

AU - Kern, Adam J.

AU - Adams, Richard

AU - Walker, Candice

AU - Schlomer, Bruce J.

AU - Jacobs, Micah A.

PY - 2017/1/1

Y1 - 2017/1/1

N2 - PURPOSE: Report urologic outcomes among newborns with spinal dysraphism managed within an expectant clean intermittent catheterization (CIC) program. METHODS: Newborns were followed clinically and with serial ultrasound (US). Urodynamics (UD) and dimercaptosuccinic acid (DMSA) renal scan were obtained at 3-6 months, 1 year, 3 years, then as needed. Patients with initial evaluation after 6 months were excluded. RESULTS: Median follow-up was 3.2 years. 11/102 began catheterization for continence (median 4.0 years) and 47/102 did not start CIC. Of these, 2/58 developed a DMSA abnormality. 44/102 began CIC early, often for elevated storage pressures and febrile urinary tract infection (UTI). Of these, 20/44 developed a DMSA abnormality including 9 who had abnormality detected prior to starting CIC. Being on CIC or starting immediately upon recognition of new hydronephrosis, reflux, elevated filling pressures, or febrile UTI was associated with lower chance of DMSA abnormalities (4/17, 24%) compared to delaying CIC (16/27, 60%) (p= 0.03). CONCLUSIONS: CIC can be deferred until continence in select infants with a low risk of significant DMSA abnormality. However, immediate initiation of CIC upon recognition of risk factors is recommended as this was associated with fewer DMSA abnormalities than delaying CIC. Recommendations for expectantly-managed patients include close follow-up, serial US and UD, and prompt initiation of CIC upon recognition of new hydronephrosis, reflux, elevated storage pressures, or febrile UTIs.

AB - PURPOSE: Report urologic outcomes among newborns with spinal dysraphism managed within an expectant clean intermittent catheterization (CIC) program. METHODS: Newborns were followed clinically and with serial ultrasound (US). Urodynamics (UD) and dimercaptosuccinic acid (DMSA) renal scan were obtained at 3-6 months, 1 year, 3 years, then as needed. Patients with initial evaluation after 6 months were excluded. RESULTS: Median follow-up was 3.2 years. 11/102 began catheterization for continence (median 4.0 years) and 47/102 did not start CIC. Of these, 2/58 developed a DMSA abnormality. 44/102 began CIC early, often for elevated storage pressures and febrile urinary tract infection (UTI). Of these, 20/44 developed a DMSA abnormality including 9 who had abnormality detected prior to starting CIC. Being on CIC or starting immediately upon recognition of new hydronephrosis, reflux, elevated filling pressures, or febrile UTI was associated with lower chance of DMSA abnormalities (4/17, 24%) compared to delaying CIC (16/27, 60%) (p= 0.03). CONCLUSIONS: CIC can be deferred until continence in select infants with a low risk of significant DMSA abnormality. However, immediate initiation of CIC upon recognition of risk factors is recommended as this was associated with fewer DMSA abnormalities than delaying CIC. Recommendations for expectantly-managed patients include close follow-up, serial US and UD, and prompt initiation of CIC upon recognition of new hydronephrosis, reflux, elevated storage pressures, or febrile UTIs.

KW - Clean intermittent catheterization

KW - DMSA abnormalities

KW - Expectant management

KW - Newborn management

KW - Renal outcomes urinary tract infection

KW - Spina bifida

KW - Spinal dysraphism

KW - Urodynamics

UR - http://www.scopus.com/inward/record.url?scp=85039415758&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85039415758&partnerID=8YFLogxK

U2 - 10.3233/PRM-170464

DO - 10.3233/PRM-170464

M3 - Article

C2 - 29125524

AN - SCOPUS:85039415758

VL - 10

SP - 319

EP - 325

JO - Journal of Pediatric Rehabilitation Medicine

JF - Journal of Pediatric Rehabilitation Medicine

SN - 1874-5393

IS - 3-4

ER -