Daniel Lodwick1, Lindsey Asti1, Katherine Deans1, Peter Minneci1, Daryl McLeod2. 1. Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH. 2. Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH. Electronic address: daryl.mcleod@nationwidechildrens.org.
Abstract
OBJECTIVE: To survey variations in recommended initial management of newborn spina bifida (SB). METHODS: Members of an international pediatric urology ListServe and of the Pediatric Urology Nurse Specialists organization were surveyed on practice patterns for newborn SB. Pediatric urologists, nurse practitioners, and physician assistants practicing in the United States were included. RESULTS: A total of 63 practitioners (48% pediatric urologists and 52% nurse practitioners or physician assistants) were included. Most practice at tertiary hospitals (94%) and about half use a protocol (56%). Recommended in-hospital screening tests include renal ultrasound (95%), voiding cystourethrogram (52%), catheterized bladder volumes (56%), and renal function tests (37%). Urodynamics are deferred until follow-up by 71%. Fifty percent of practitioners initiate clean intermittent catheterization (CIC) on all newborns, whereas 43% wait for symptoms. The majority of those who start CIC continue until residual volumes are below a threshold. Few recommend prophylactic antibiotics routinely (13%), or in patients on CIC (19%), but most recommend it for urinary reflux (62% grades 1-2, 79% grade 3, and 87% grades 4-5). Anticholinergics are deferred until after urodynamics (68%). Practicing at an institution with a pediatric urology fellowship program or an SB treatment protocol was associated with differing diagnostic work-up and urologic management. CONCLUSION: There is variability in management of newborn SB among pediatric urology providers at tertiary care centers that may be influenced by institutional factors such as the presence of a pediatric urology fellowship or the presence of a protocol to care. This highlights the need for prospective multicenter projects to better understand how variations in management affect patient outcomes.
OBJECTIVE: To survey variations in recommended initial management of newborn spina bifida (SB). METHODS: Members of an international pediatric urology ListServe and of the Pediatric Urology Nurse Specialists organization were surveyed on practice patterns for newborn SB. Pediatric urologists, nurse practitioners, and physician assistants practicing in the United States were included. RESULTS: A total of 63 practitioners (48% pediatric urologists and 52% nurse practitioners or physician assistants) were included. Most practice at tertiary hospitals (94%) and about half use a protocol (56%). Recommended in-hospital screening tests include renal ultrasound (95%), voiding cystourethrogram (52%), catheterized bladder volumes (56%), and renal function tests (37%). Urodynamics are deferred until follow-up by 71%. Fifty percent of practitioners initiate clean intermittent catheterization (CIC) on all newborns, whereas 43% wait for symptoms. The majority of those who start CIC continue until residual volumes are below a threshold. Few recommend prophylactic antibiotics routinely (13%), or in patients on CIC (19%), but most recommend it for urinary reflux (62% grades 1-2, 79% grade 3, and 87% grades 4-5). Anticholinergics are deferred until after urodynamics (68%). Practicing at an institution with a pediatric urology fellowship program or an SB treatment protocol was associated with differing diagnostic work-up and urologic management. CONCLUSION: There is variability in management of newborn SB among pediatric urology providers at tertiary care centers that may be influenced by institutional factors such as the presence of a pediatric urology fellowship or the presence of a protocol to care. This highlights the need for prospective multicenter projects to better understand how variations in management affect patient outcomes.
Authors: Stacy T Tanaka; Pangaja Paramsothy; Judy Thibadeau; John S Wiener; David B Joseph; Earl Y Cheng; Duong Tu; Christopher Austin; Chester J Koh; M Chad Wallis; William O Walker; Kathryn A Smith; Jonathan C Routh; Michelle A Baum Journal: J Urol Date: 2019-06 Impact factor: 7.450