| Congenital malformations of the kidney and urinary tract(CAKUT)are a series of abnormal development of the kidneys,ureters,bladder and urethra.Most of them are caused by genetic mutations and environmental factors during embryonic development.The incidence rate abroad reaches 6‰,about it accounts for 20-30%of birth defects.Hydronephrosis is the most common type of CAKUT.Some CAKUTs such as congenital pelvic ureteral obstruction(UPJO)and urethral valvular disease(PUV)can only manifest as hydronephrosis.There are few prospective cohort reports on the occurrence and development of children with CAKUT who are screened early.Objective:To investigate the early onset of children congenital anomalies of the kidney and urinary tract and the significance of screening,follow up the changes after birth.Methods:This study is a single-center prospective cohort study1.objects:Newborns born within one week of the obstetrics department of Bo’ai Hospital,Zhongshan City from August 2019 to July 2020.2.methods:(1)During the study period,newborns born within 1 week of the obstetrics department of the hospital were continuously included in the urinary tract ultrasound screening;(2)Compared with the intrauterine three-dimensional ultrasound of the fetus before birth,compared with the positive intrauterine and extrauterine CAKUT;(3)Follow-up for those who meet the CAKUT standard,and analyze the changes and complications from 1 to 3 months and 3 to 6 months after birth.3.Statistical methods:Data was analysised by SPSS 22 software.The count data was expressed in ratio/rate,and the comparison between groups was performed using the χ2 test,the infection rate is expressed with 95%confidence interval,when P<0.05,the difference is statistically significant.Results:1.The overall screening situation:From August 2019 to July 2020,6762 were born in the obstetrics department of Bo’ai Hospital in Zhongshan City.A total of 4877 newborns were screened within one week,the screening rate was 72.12%.4,811 newborns was recorded whole information,and 268 were positive for early CAKUT,including 172 males and 96 females,with a positive rate of 5.57%;the ratio of male to female was 1.79:1(χ2=248.306,P<0.05).Hydronephrosis was the most common one,accounting for 92.54%,other common CAKUTs include duplex kidney,kidney cysts,ureteral cysts,and kidney absent.2.Positive results of hydronephrosis screening:the positive rate is 5.15%,164 males and 84 females;213 mild,19 moderate and 16 severe;165 on the left,48 on both sides,34 on the right side;213 intrauterine ultrasound were normal,and the positive rate of intrauterine ultrasound was 2.30%(111/4811),among them,76(68.47%)were normal within one week after birth.Compared with the positive rate of postnatal screening of 5.15%,there was a significant difference(χ2=99.408,P<0.05).3.Changes in hydronephrosis:①1 to 3 months after birth:125 disappeared,37 improved,61 were stable,18 progressed(16 were mild),7 performed urinary tract infection(UTI);the disappearance and the improvement accounted for 65.32%totally,and the severe accounted for 7.26%.② 3 to 6 months after birth:170 disappeared,20 improved,35 were stable,4 progressed(all mild),and 15 performed UTI,of which 3 were second infections;③68.55%of spontaneous disappearance were mild and moderate hydronephrosis;16 severe and 4 progressed mild were performed MRU or CTU examination,15 UJPO and 1 PUV were found;there was no unilateral development to bilateral.4.Complication:During the follow-up,7.66%(19/248,13 males and 6 females)complicated with UTI(95%CI:4.4%～11%),the differences were statistically significant comparing with 3.3%of normal infants with UTI;1 to 3 months after birth,7 complicated UTI,including 5 mild and 2 severe;3 to 6 months after birth,15 complicated UTI,of which 12 were mild,3 were severe,and 3 were secondary infections;the differences between the rate of mild hydronephrosis(5.64%,14/213)and severe hydronephrosis(31.25%,5/16)were statistically significant(χ2=411.776,P<0.05).Among 19 UTI,13 were performed MCU examination,and 7 were diagnosed with VUR,5 males and 2 females,all were mild hydronephrosis,2 gradeⅡ,3 grade Ⅲ,and 2 grade Ⅳ.Treatment:19 patients with UTI required antibiotic treatment,.12 severe hydronephrosis improved after surgery,5 VUR required long-term low-dose antibiotics prophylaxis.eGFR were performed for patients with severe hydronephrosis,exacerbation of APD,and complications,and the results were fine.Conclusion:The positive rate of early CAKUT screening in neonates was 5.57%.Hydronephrosis was the most common,with a positive rate of 5.15%.The positive rate of ultrasound screening after birth was significantly higher than that of intrauterine screening.68.5%of mild to moderate hydronephrosis disappeared spontaneously within 6 months after birth,and most of the severe and mild to moderate hydronephrosis progressed during follow-up were pathological obstruction.The rate of complicated UTI in infants with hydronephrosis is higher than that in ordinary infant. |
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