Objective:The most common indication for neonatal renal ultrasound is the antenatal finding of pyelectasis followed by suspected renal anomaly. Some of the latter have a characteristic appearance suggesting the diagnosis. This 5-year audit of 778 neonates reviewed the outcome of those with persisting pyelectasis and renal anomalies and suggested protocols for investigation. Method: The Mercy Hospital for Women is a tertiary referral obstetric and gynaecology hospital with a level-3 neonatal intensive care unit and approximately 5000 deliveries a year. A computer search of neonatal renal scans for the years 1996-2000 was made.Neonates with persisting pyelectasis and renal anomalies were reviewed. A micturating cystourethrogram (MCU) was requested in a number of infants. Vesicoureteric reflux (VUR) was classified according to the International Classification of Reflux. The results of investigations and outcome are reported. Results: In the 5 years, 25,204 babies were born at the Mercy Hospital for Women, 778 neonates (3%) were referred for renal ultrasound. The results were classified according to the postnatal diagnosis. Of 592 (76%) with normal postnatal scans, 49 had an MCU and 19 had VUR. There were 120 (15%) with persisting pyelectasis, 15 (13%) with VUR, not always ipsilateral. There were 7 with unilateral renal obstruction. There were 59 (8%) with structural anomalies including multicystic dysplastic kidney (MCDK), anatomic variants, ureterocoeles, reflux nephropathy, polycystic kidney disease and urethral obstruction. Conclusion: In this consecutive series, there were 100 (13%) neonates with significant abnormalities, structural anomalies, unilateral renal obstruction and VUR affecting clinical management. Protocols for investigation of neonates with persisting pyelectasis, severe hydronephrosis and renal anomalies are suggested.
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Hôpital Necker-Enfants Malades, Paris, FranceObjective: The aim of this study is to present the three-dimensional Doppler-ultrasound contribution to the prenatal diagnosis of lung sequestration. Methods: Prenatal three-dimensional angiosonography was used to image pulmonary blood supply in 20 normal controls and to screen for an abnormal pulmonary blood supply in 6 fetuses with hyperechogenic lung lesions. Post natally (n = 5) or post mortem (n = 1), these lesions turned to be an isolated lung sequestration (n = 2), a type III congenital adenomatoid malformation (n = 2), a type I + III congenital adenomatoid malformation (n = 1), or a complex malformation in which a left congenital diaphragmatic hernia was associated with both lung sequestration and type III adenomatoid malformation (n = 1, termination of pregnancy). Results: Three-dimensional angiosonography demonstrated clearly an abnormal blood supply before 20 weeks of gestation in the three cases that turned to be lung sequestrations, and in none of the other cases. In 2 of the three cases with pulmonary sequestration, 2D ultrasound initially failed to identify the feeding vessel. Conclusion: Three-dimensional ultrasoun...