Cost-benefit analysis of ultrasound screening for vesicoureteral reflux in neonates

本研究对大量表面健康的新生儿进行了尿路异常超声筛查，发现肾脏发育不全与输尿管反流密切相关，排尿时伴有短暂的盆腔扩张。本研究在大约1%的婴儿中有效地确定了膀胱输尿管反流，并观察到男性婴儿的输尿管反流发生率大约是女性的两倍，而肾脏发育不全伴反流的发生率为男孩的1 / 300。这些发现强烈提示，发生尿路感染的男婴肾脏小，几乎总是与先天性肾脏发育不全有关。最近的调查发现，大多数需要肾脏替代治疗的儿童患有严重的阻塞性肾病或肾脏发育不良。这些严重的肾脏畸形似乎有效地发现胎儿超声，这是常规执行的产科医生。对于那些在胎儿超声检查中被怀疑有肾脏异常的婴儿，在出生后进行检查似乎是最划算的。

The present study on ultrasound screening for urinary tract anomalies in a large number of apparently healthy neonates revealed that hypoplastic kidneys were highly associated with ureteric reflux and that significant ureteric reflux presented with transient pelvic dilation on voiding. The present study effectively identified vesicoureteral reflux in approximately 1% of babies and observed that male babies had ureteric reflux approximately two times as often as females and that renal hypoplasia with reflux was found with an incidence of 1 in 300 boys. These findings strongly suggest that small kidneys often found in male infants who developed urinary infection were almost always associated with congenital hypoplastic kidneys. Recent investigation observed that most of children who required renal replacement therapy had had severe obstructive nephropathy or hypodysplastic kidneys. These severe renal malformations seem efficiently found in fetal ultrasound which is routinely performed by obstetrician. It seems most cost-effective to examine only these babies after birth who are suspected of having renal anomalies on fetal ultrasound.