The outcome of antenatal ultrasound diagnosed anomalies of the kidney and urinary tract in a large Danish birth cohort

OBJECTIVE

Antenatal ultrasound diagnosed anomalies of the kidney and urinary tract (AUDAKUT) are reported in 0.3%-5% on prenatal ultrasound (US) and 0.3%-4.5% on postnatal US. The anterior-posterior diameter of the renal pelvis (APD) is an essential measurement. Series with low threshold values of APD prenatally and postnatally will include healthy infants. It is important to avoid follow-up of such infants.

INTERVENTIONS

In 2006, new Danish guidelines for AUDAKUT were introduced.

AIM OF STUDY

Investigations of incidences and type of AUDAKUT based on Danish guidelines, including long-term follow-up.

DESIGN

Cohort study.

SETTING

Copenhagen University Hospital Hvidovre and Copenhagen University Hospital Rigshospitalet, Denmark.

PATIENTS

Consecutive cases with AUDAKUT in the second and third trimesters, which were either terminated before 22 completed weeks of gestation or born in the 8-year period January 2006-December 2013. Patients were followed until June 2014.

RESULTS

50 193 live born children and 24 terminated fetuses (0.05%) were included. The prevalence of AUDAKUT was only 0.39% prenatally, 0.29% at first postnatal US and 0.22% at the end of follow-up, including terminated cases. The greater the prenatal and postnatal APD, the higher risk of febrile urinary tract infection (fUTI) and surgical intervention, and lower probability of resolution. 25% of the identified patients had fUTI and/or surgery.

CONCLUSIONS

We recommend threshold values of APD at least 10 mm in the third trimester and in general at least 12 mm at first postnatal US for intensive follow-up. In this largest to date unselected birth cohort of AUDAKUT, the incidences of clinically significant AUDAKUT were in the lowest range of those previously published.

Accurate volume ventilation of neonates with maintenance of humidification

A method is presented for producing adequate humidification and accurate volume ventilation of neonates. This was effected by pressurizing the humidifier and fresh gas flow up to the T-piece. By using a ventilator which acted as a timed occluder of the T-piece, the system functioned as an accurate flow generator. Its precision of ventilation was confirmed with a neonatal test lung.