Patients with a prenatal diagnosis of lower urinary tract obstruction (LUTO) may undergo prenatal interventions, such as vesicoamniotic shunt (VAS) placement, as a temporary solution for relieving urinary tract obstruction. A recent FDA communication has raised awareness of the potential neurocognitive adverse effects of anesthesia in children. We hypothesized as to whether a prenatal LUTO staging system was predictive of the number of anesthesia events for prenatally diagnosed LUTO patients.
We retrospectively reviewed the prenatal and postnatal clinical records for patients with prenatally diagnosed LUTO from 2012 to 2015. Patients were stratified by prenatal VAS status and by LUTO disease severity according to Ruano et al. (Ultrasound Obstet Gynecol. 2016).
31 patients were identified with a prenatal LUTO diagnosis, and postnatal records were available for 21 patients (seven patients in each stage). When combining prenatal and postnatal anesthesia, there was a significant difference in the number of anesthesia encounters by stage (1.6, 3.7, and 6.7 for Stage I, II, and III respectively, p = .034). Upon univariate analysis, higher gestational age (GA) at birth was associated with a decreased number of anesthesia events in the first year (p = .031).
The majority of infants with prenatally diagnosed LUTO will undergo postnatal procedures with general anesthesia exposure in the first year of life. Patients with higher prenatal LUTO severity experienced a higher number of both prenatal and postnatal anesthesia encounters. In addition, higher GA at birth was associated with fewer anesthesia encounters in the first year.
This is a prognostic study with Level IV evidence.
Journal of pediatric surgery. 2018 Jul 06 [Epub ahead of print]
Kathleen T Puttmann, Jeffrey T White, Gene O Huang, Kunj Sheth, Rodolfo Elizondo, Huirong Zhu, Michael C Braun, David G Mann, Olutoyin A Olutoye, Duong D Tu, Rodrigo Ruano, Michael Belfort, Mary L Brandt, David R Roth, Chester J Koh
Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, and Scott Department of Urology, Baylor College of Medicine, Houston, TX. Electronic address: ., Division of Pediatric Urology, Department of Surgery, Texas Children's Hospital, and Scott Department of Urology, Baylor College of Medicine, Houston, TX., Outcomes & Impact Services, Texas Children's Hospital, Houston, TX., Renal Section, Department of Pediatrics, Texas Children's Hospital, Houston, TX., Department of Anesthesiology, Texas Children's Hospital, Houston, TX., Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN., Department of Women Services, Texas Children's Hospital, Houston, TX., Division of General Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX.