Outcome and management of isolated severe renal pelvis dilatation detected at postnatal screening.

The aim of this study was to evaluate the incidence and outcome of isolated severe renal pelvis dilatation (RPD; APD>15or=3 and 16 with ureteropelvic junction obstruction (UPJO). Incidence of UTI was significantly higher (p<0.001) in infants of the study group than in infants of the control group (13.9 vs 2.5%). Our data suggest that isolated severe RPD may be a self-limiting condition and that antibiotic prophylaxis (AP) for the prevention of UTI should not be performed. Considering RDP resolution and the incidence of UTI during follow-up, investigations for uropathy in infants with isolated, severe RPD are justified in persistent cases, or when UTI occurs during follow-up. Careful clinical monitoring for signs of UTI and treatment of each episode of UTI may be sufficient and safe.

Outcome and management of isolated moderate renal pelvis dilatation detected at postnatal screening.

The aim of this study was to evaluate the incidence and outcome of isolated moderate renal pelvis dilatation (RPD) [anterior-posterior diameter (APD) 10-15 mm] in an unselected population of 2-month-old infants prospectively followed for up to 12-14 months of life. Isolated moderate renal pelvis dilatation was detected in 282 of the 11,801 (2.4%), infants screened; 240 infants with normal renal ultrasound were enrolled as the control group. Resolution of RPD was considered when an APD

Is a complete urological evaluation necessary in all newborns with asymptomatic renal ectopia?

AIM: To evaluate if a complete urological screening is justified by potential urological anomalies in newborns or infants with asymptomatic renal ectopia (RE). METHODS: The database records of 60 consecutive neonatal cases of RE diagnosed at the authors' hospital from 1990 to 2004 were retrospectively reviewed. RESULTS: At diagnosis, mean patient age was 1.6 months. In 58 of 60 patients, the suspected diagnosis of RE was made during prenatal or postnatal screening ultrasonography, including two newborns with anorectal malformation. There were 24 patients with crossed RE (C-RE) and 36 patients with simple RE (S-RE). A solitary RE was present in two patients. The most frequent associated urological abnormality was vesico-ureteral reflux (37.5% of C-RE and 16.6% of S-RE). Hydronephrosis was detected in seven RE and five contralateral kidneys. An obstructive megaureter was present in one patient with C-RE. In 40% of S-RE and 92.9% of C-RE, the (99m)Tc DMSA documented reduction of function of RE. The longitudinal diameter of the ectopic kidney was significantly smaller than the contralateral one. Other non-renal diseases were present in 15% of patients, of which the most frequent was cryptorchidism (6.6%). CONCLUSIONS: A complete urological evaluation is necessary in newborns with C-RE for the high incidence of associated urological anomalies, of which VUR is the most frequent. A complete urological evaluation is also reasonable in patients with S-RE who have a pelvic dilatation. No diagnosis or treatment of the associated urological diseases, in consideration of congenital decreased function of the ectopic kidney, might predispose these children to improvement of renal function impairment.

Breast milk sodium concentration, sodium intake and weight loss in breast-feeding newborn infants.

Elevated breast milk (BM) Na concentration is regarded as responsible for elevated Na intake. To verify the clinical significance of milk Na concentration, we studied the relationship between BM Na+ concentration and infants' daily Na+ intake, infants' daily BM intake (DBMI) and percentage weight loss (%WL) in healthy newborn infants. All mothers who gave birth to a single healthy infant, between February and March 2004 at the Obstetric Clinic of University of Messina (Italy), were invited to participate if they were willing to attempt to breastfeed exclusively. BM Na+ concentration, DBMI, Na+ intake and %WL were determined on the third day after delivery. Statistical analysis was performed by Spearman's correlation test, classification and regression trees and the generalised linear model. Of the 270 eligible mothers, 208 participated in the study. The results showed that on the third day postpartum BM Na+ concentration was 23.05 (SD 1.10) mmol/l, mean DBMI was 202 (SD 68.9) g/d, and mean Na+ intake was 4.36 (SD 0.22) mmol/d and 1.36 (SD 0.07) mmol/kg per d. BM Na+ concentration was inversely related to infant DBMI, and Na+ intake was directly related to infant DBMI and not to BM Na+ concentration. %WL was significantly correlated only to DBMI. In conclusion, the present data demonstrate, for the first time, that when lactogenesis is suboptimal, BM Na+ concentration is higher, but infants' Na+ intake is lower. Finally, the present data probably suggest that for the clinical assessment of breast-feeding, evaluation of milk intake remains the best method.

Endothelin-1 concentrations in cord blood of neonates with meconium-stained amniotic fluid.

BACKGROUND: The effects of meconium-stained amniotic fluid (MSAF) on cord blood endothelin-1 (ET-1) concentrations have not been explored. OBJECTIVE: The aim of this study was to verify whether MSAF influences ET-1 cord blood concentrations in healthy term neonates. METHODS: Using an enzyme-linked immunosorbent assay, plasma ET-1 concentrations were determined in 30 healthy term neonates with MSAF, and in 15 healthy term neonates without MSAF. The two groups were of the same gestational age, weight, Apgar score, cord blood pH, base excess, and hematocrit values, as well as systolic and diastolic blood pressures. RESULTS: ET-1 plasma concentrations were not significantly different between the two groups and did not correlate with cord blood pH or base excess values. CONCLUSION: Our data demonstrate that meconium passage does not induce ET-1 secretion.