Vesicoureteral Reflux in Children: Comparison of Contrast - Enhanced Voiding Ultrasonography with Radiographic Voiding Cystourethrography: Preliminary Report

PURPOSE: To compare the usefulness of contrast-enhanced voiding ultrasonography(US) with that of radiographic voiding cystourethrography(VCUG) for the diagnosis of vesicoureteral reflux(VUR) in children. MATERIALS AND METHODS: Ninety-five kidney-ureter units of 47 patients referred for investigation of VUR underwent contrast-enhanced voiding US followed by radiographic VCUG. After baseline US examination of the urinary tract, residual urine in the bladder was drained through an inserted Foley catheter and the bladder was gravity filled at a height of 1 m with normal saline. A galactose-based, microbubble-containing echo-enhancing agent (Levovist; Schering, Berlin, Germany) was then administered. The amount of this was approximately 10% of bladder capacity, and VUR was diagnosed when microbubbles appeared in the ureter or pelvo-calyceal system. Using radiographic VCUG as a reference point, the accuracy with which contrast-enhanced voiding US detected VUR was calculated. RESULTS: In 87 of 95 kidney-ureter units (91.6%), the two methods showed similar results regarding the diagnosis or exclusion of VUR, which was detected by both in 12 units, but by neither in 75. VUR was shown to occur in a total of 20 units, but in eight of these by one method only. In two units, VUR detected by contrast-enhanced voiding US was not demonstrated by radiographic VCUG; in six units, the reverse was true. In the detection of VUR, contrast-enhanced voiding US showed a sensitivity of 66.7%, a specificity of 97.4%, a positive predictive value of 85.7%, and a negative predictive value of 92.6%. CONCLUSION: Contrast-enhanced voiding US is highly specific and has high positive and negative predictive values; its sensitivity, however, is not sufficiently high. The modality appears to be a useful diagnostic tool for the detection of VUR without exposure to ionizing radiation, though to be certain of its value, more experience of its use is first required.

Total Parenteral Nutrition-associated Cholestasis in Very Low Birth Weight Infants

PURPOSE: Very low birth weigh infants (VLBWI), who often require a long-term parenteral nutrition, are at high risk for the development of parenteral nutrition-associated cholestasis. This study was conducted to determine the incidence of total parenteral nutrition (TPN)-associated cholestasis and its risk factors in the VLBI. We evaluated the clinical courses and outcomes. METHODS: The hospital records of 165 VLBWI who were admitted to the neonatal intensive care unit at Asan medical center from Jan. 1997 to Dec. 1999 and received TPN for more than 2 weeks were reviewed. Cholestasis was defined as a direct serum bilirubin level greater than 2.0 mg/dl during the period of TPN, and other causes of cholestasis were ruled out. RESULTS: Twenty-seven out of 165 VLBWI developed TPN-associated cholestasis with the incidence of 16.4%. Significant risk factors for the development of cholestasis included birth weight, small for gestational age, duration of enteral starvation, duration of parenteral nutrition, septic episodes, necrotizing enterocolitis, and the number of surgery in 30 days of age. Cholestasis occurred at the mean age of 48.8+/-20.7 days and resolved in 53.7+/-8.8 days after onset of cholestasis. The mortality rate of infants with cholestasis was significantly higher than that of infants without cholestasis. Two infants appeared to die of a progressive hepatic dysfunction associated with TPN. CONCLUSION: TPN-associated cholestasis is relatively common in VLBWI, and may progress to the hepatic failure and death. The strategies such as early enteral feeding or the reduction of septic episodes would need to be seriously adopted in order to prevent the morbidity and mortality from TPN-associated cholestasis.

Total Parenteral Nutrition-associated Cholestasis in Very Low Birth Weight Infants

PURPOSE: Very low birth weigh infants (VLBWI), who often require a long-term parenteral nutrition, are at high risk for the development of parenteral nutrition-associated cholestasis. This study was conducted to determine the incidence of total parenteral nutrition (TPN)-associated cholestasis and its risk factors in the VLBI. We evaluated the clinical courses and outcomes. METHODS: The hospital records of 165 VLBWI who were admitted to the neonatal intensive care unit at Asan medical center from Jan. 1997 to Dec. 1999 and received TPN for more than 2 weeks were reviewed. Cholestasis was defined as a direct serum bilirubin level greater than 2.0 mg/dl during the period of TPN, and other causes of cholestasis were ruled out. RESULTS: Twenty-seven out of 165 VLBWI developed TPN-associated cholestasis with the incidence of 16.4%. Significant risk factors for the development of cholestasis included birth weight, small for gestational age, duration of enteral starvation, duration of parenteral nutrition, septic episodes, necrotizing enterocolitis, and the number of surgery in 30 days of age. Cholestasis occurred at the mean age of 48.8+/-20.7 days and resolved in 53.7+/-8.8 days after onset of cholestasis. The mortality rate of infants with cholestasis was significantly higher than that of infants without cholestasis. Two infants appeared to die of a progressive hepatic dysfunction associated with TPN. CONCLUSION: TPN-associated cholestasis is relatively common in VLBWI, and may progress to the hepatic failure and death. The strategies such as early enteral feeding or the reduction of septic episodes would need to be seriously adopted in order to prevent the morbidity and mortality from TPN-associated cholestasis.