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: 9318125
• 负责人: Heidi Castillo
• 金额: $ 2.05万
• 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/9318125
• 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)：(C部分)脊柱裂(SB)是儿童中最常见的永久性致残出生缺陷，在美国每2000名活产儿中就有一名受到影响。超过7万人与SB及其对多个器官系统的长期影响一起生活。对于SB新生儿的泌尿外科治疗，通过适当的膀胱管理保护上尿路，从而避免肾功能的永久性丧失，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的新生儿通常被安排进行密切观察，包括对尿路和尿动力学进行连续成像，以及清洁间歇插管(CIC)和抗胆碱能药物等治疗选择。该方法的基本原理是通过膀胱循环促进逼尿肌松弛和发育，并确保膀胱引流，以保护上尿路和预防肾积水。然而，这种治疗的结果没有得到很好的记录，特别是在那些被认为肾损害风险较低的患者中，当根据密切的观察方案对所有新生儿患者进行跟踪时，尚不清楚CIC和抗胆碱能药物的干预是否适合所有新生儿患者。该项目的长期目标是改善儿童SB患者的临床管理。其目的是实施和评估在疾控中心开发的最佳实践泌尿学方案，该方案将导致对患有SB的新生儿和幼儿进行有效和有效的尿路护理的标准化管理方案，至少在生命的前五年保留肾功能。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，保护长期的肾功能。拟议研究的理由是，已经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人患者护理以及公共卫生/人口健康产生了积极影响。我们将验证我们的中心假设，并通过作为疾控中心注册网站参与的具体目标来检验我们的中心假设，该网站将实施和评估患有脊柱裂的幼儿的泌尿系统管理保留肾功能协议。由于我们机构庞大而独特的人口，国家登记的登记对象将包括产前闭合患者和种族多样化的患者，包括具有西班牙裔背景的患者。