Comp C-Urologic Management for Young Children with SB at TCH/BCM

Comp C-TCH/BCM 的 SB 幼儿泌尿科管理

• 批准号: 8817781
• 负责人: Heidi Castillo
• 金额: $ 1.95万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8817781
• 关键词: Comp; Urologic; Management; Young; Children

DESCRIPTION (provided by applicant): (Component C) Spina bifida (SB) is the most common permanently disabling birth defect in children and affects 1 in 2,000 live births in the United States. More than 70,000 people live with SB and its long-term effects on multiple organ systems. For the urologic management of newborns with SB, preservation of the upper urinary tracts and thus avoiding permanent loss of renal function via appropriate bladder management has been a key management goal for pediatric urologists and SB healthcare providers. Newborns with SB are generally placed on a close observation protocol that includes serial imaging of the urinary tract and urodynamics, as well as treatment options such as clean intermittent catheterization (CIC) and anticholinergic medications. The rationale behind this approach is to promote detrusor muscle relaxation and development by bladder cycling and ensure bladder drainage to protect the upper urinary tract and prevent hydronephrosis. However, the outcomes of this management are poorly documented, especially in patients who are presumed at low risk for renal damage, and it is unclear if the interventions of CIC and anticholinergics are appropriate for all newborn patients when they are followed under a close observation protocol. The long-term goal of this project is to improve the clinical management of pediatric patients with SB. The objective is to implement and evaluate the best practice urologic protocol that was developed at the CDC that will lead to a standardized management protocol of efficient and effective urinary tract care in newborns and young children with SB that preserves renal function for at least the first five years of life. Our central hypothesis is that a standardzed management protocol will promote efficient use of health care resources and effective clinical management that preserves long-term renal function with minimized morbidity. The rationale for the proposed research is that standardized management protocols that have been implemented in other clinical areas such as cystic fibrosis and congenital heart conditions that have positivel influenced individual patient care as well as public health / population health. We will test our central hypothesis and accomplish the objective of this proposal by pursuing the specific aim of participating as a CDC registry site that will implement and evaluate the Urologic Management to Preserve Renal Function Protocol for Young Children with Spina Bifida. Due to the large and unique population at our institution, enrollees to the national registry will include prenatal closre patients and ethnically diverse patients including those with Hispanic backgrounds.

描述（由申请人提供）：（成分C）脊柱裂（SB）是儿童中最常见的永久性残疾出生缺陷，在美国每2000个活产婴儿中就有1个受到影响。超过7万人患有SB，并对多个器官系统产生长期影响。对于新生儿SB的泌尿系统管理，通过适当的膀胱管理来保护上尿路，从而避免永久性肾功能丧失一直是儿科泌尿科医生和SB医疗保健提供者的关键管理目标。患有SB的新生儿通常接受严密的观察方案，包括尿路和尿动力学的连续成像，以及清洁间歇导尿（CIC）和抗胆碱能药物等治疗方案。这种方法的基本原理是通过膀胱循环促进逼尿肌的松弛和发育，并确保膀胱引流，以保护上尿路，防止肾积水。然而，这种治疗的结果文献很少，特别是在那些被认为肾损害风险较低的患者中，而且尚不清楚在严密观察方案下，CIC和抗胆碱能药物的干预是否适用于所有新生儿患者。该项目的长期目标是改善小儿SB患者的临床管理。目标是实施和评估由CDC制定的最佳泌尿学方案，该方案将导致对SB新生儿和幼儿进行高效和有效的尿路护理的标准化管理方案，并至少在生命的前五年保持肾功能。我们的中心假设是，标准化的管理方案将促进卫生保健资源的有效利用和有效的临床管理，以最大限度地减少发病率，保持长期肾功能。拟议研究的基本原理是，在囊性纤维化和先天性心脏病等其他临床领域实施的标准化管理方案对个体患者护理以及公共卫生/人口健康产生了积极影响。我们将检验我们的中心假设，并通过追求作为CDC注册站点的具体目标来实现本提案的目标，该注册站点将实施和评估脊柱裂幼儿泌尿系统管理以保护肾功能方案。由于我们机构的庞大而独特的人口，国家登记的入选者将包括产前封闭患者和种族多样化的患者，包括具有西班牙裔背景的患者。