Fetal urine biochemistry in the assessment of obstructive uropathy

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Citations from the Literature

biophysical profile or FHR variation were not significantly different between the two outcome groups. The 36 pregnancies delivered between 37 and 42 weeks were matched retrospectively for maternal age, parity and race with 36 pregnancies without APH; there was no significant difference in outcome between the women with unexplained APH and the matched comparison group. Conclusion: Morbidity related to unexplained APH is associated with preterm delivery rather than with damage to utero-placental function. Reliability and effectiveness of screening for hearing 10~sin kigb risk neonates McClelland RJ; Watson DR; Lawless V; Houston HG; Adams D Department of Mental Health, Queen’s University, Belfast BT9 7BL. GBR

BR MED J 1992 304/6830 (806-809) Objective - To establish the reliability and effectiveness of screening for hearing loss by brainstem auditory evoked potential testing in high risk neonates. Design - Seven year investigation of newborn babies admitted to a special care baby unit and monitored through a regional children’s audiology unit. Setting - Special care baby unit and children’s audiology department, Belfast. Subjects - 405 neonates admitted to the baby unit, during 1 October 1982 to 31 March 1987. Main outcome measures - Presence of hearing impairment, type and severity of hearing impairment, mortality. Results - 85 children failed the screening test, 62 of whom were followed up. Five children had severe bilateral sensorineural impairment and 12 had conductive impairment requiring surgical intervention. A further 18 had severe neurological disorder detected. The sensitivity of screening was 100% and specificity was 88%. If the procedure was introduced into routine clinical practice the mean age at diagnosis for all children with severe perinatal hearing impairment would be 11 (median I) months. The mean age at diagnosis with the health visitor screening service was 23 (19) months (difference 10 months, 95% confidence interval 6 to 16 months; P < 0.0001). Conclusion - Screening for hearing loss in high risk neonates is highly reliable and cost effective. It also provides valuable neurophysiological information. Routine testing of these infants would result in over half of all children with severe bilateral perinatal sensorineural hearing impairment being identified by 2 months of age. This would make an important contribution to the habilitation of this socially, emotionally, and educationally vulnerable group. Avoidance of emergency surgery in newborninfants with trisomy 18 Bos AP; Broers CJM; Hazebroek FWJ; Van Hemel JO; Tibboel D; Wesby-Van Swaay E; Molenaar JC NLD

LANCET 1992 33918798(913-915) Trisomy 18 (Edwards’ syndrome) presents with characteristic external features as well as life-threatening abnormalities; many of these abnormalities require surgical correction during the neonatal period. Children with trisomy 18 have a very short life expectancy and all long-term survivors have severe mental ht J Gynecol Obstet 39

retardation. Difftcuh medical and ethical issues arise over whether or not to institute treatment when a newborn infant with suspected trisomy 18 has a life-threatening anomaly. We studied the policy of treatment in seven patients with clinical Edwards’ syndrome. For three, the period of uncertainty was shortened because trisomy 18 was rapidly diagnosed by karyotyping of a bone-marrow aspirate. Four of the patients underwent surgery before the diagnosis of trisomy 18 was confirmed by routine karyotyping in lymphocytes; karyotyping in bone marrow might have allowed invasive treatment to be avoided in three of these. Rapid confirmation of clinically suspected Edwards’ syndrome is very important because surgery may then be withheld. A newborn infant with trisomy 18 should be considered as a patient with a hopeless outlook who ought not to be subjected to invasive procedures. The decision to withdraw or withhold treatment should be discussed frankly with the parents. The period of uncertainty can be reduced to a minimum by the use of karyotyping in bone marrow. Fetal urine biochemistry in the assessment of obstructive oropatby Nicolaides KH; Cheng HH; Snijders RJM; Moniz CF Kings College Hospital School of Medicine, Denmark Hill, London SES 8RX. GBR

AM J OBSTET GYNECOL 1992 166/3 (932-937) In 60 fetuses with obstructive uropathy, sodium, total calcium, urea and creatinine were measured in samples obtained by ‘urodochocentesis’ or pyelocentesis at 16 to 36 weeks’ gestation. The patients were retrospectively assigned into two groups on the basis of outcome. Group 1 (n = 20) included infants who either had normal postnatal renal function or absence of prenatal renal dysplasia. Group 2 included infants who either had histologic evidence of renal dysplasia or subsequently developed renal failure. In group 1 the urinary sodium decreased and creatinine increased with gestation, demonstrating maturation in fetal renal function. In group 2 the urinary sodium and calcium were higher and the urinary urea and creatinine were lower than in group 1. The best predictor of outcome was the combination of either high calcium or high sodium with a positive predictive value of 91.3% and negative predictive value of 77.7%. In the antenatal evaluation of obstructive uropathy, fetal urinary biochemistry provides useful information for more accurate counseling of the parents and a rational basis for selecting patients who may benefit from intrauterine therapeutic interventions. Atrial natriuretic peptide, cyclic guanosine monophosphate and sodium excretion during postnatal adaptation in male infants below 34 weeks gestation witb severe respiratory distress syndrome Midgley J; Modi N; Littleton P; Carter N; Royston P; Smith A Department of Paediatrics. Royal Postgraduate Medical School, Queen Charlotte5 and Chelsea Hospital, Goldhawk Road, London W6 OXG, GBR

EARLY HUM DEV 1992 28/2 (145-154) The role of atria1 natriuretic peptide (ANP), in the perinatal