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

Issue title: Spina Bifida

Guest editors: Timothy Brei and Amy Houtrow

Article type: Research Article

Authors: Timberlake, Matthew D.^{a; *} | Kern, Adam J.^a | Adams, Richard^b | Walker, Candice^b | Schlomer, Bruce J.^a | Jacobs, Micah A.^a

Affiliations: [a] Division of Pediatric Urology, University of Texas Southwestern/Childrens’ Medical Center, Dallas, TX, USA | [b] Department of Pediatrics, University of Texas Southwestern/Texas Scottish Rite Hospital for Children, Dallas, TX, USA

Correspondence: [*] Corresponding author: Matthew D. Timberlake, Pediatric Urology Fellow, University of Texas Southwestern/Childrens’ Medical Center, 1935 Medical District Drive Suite F4300, mail code F404, Dallas, TX 75235, USA. Tel.: +1 214 456 5632; Fax: +1 214 456 0126; E-mail: [email protected].

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: Spinal dysraphism, spina bifida, newborn management, clean intermittent catheterization, expectant management, DMSA abnormalities, urodynamics, renal outcomes urinary tract infection

DOI: 10.3233/PRM-170464

Journal: Journal of Pediatric Rehabilitation Medicine, vol. 10, no. 3-4, pp. 319-325, 2017