Title: Nephrocalcinosos and Prematurity -Is It Time to Change Practice?

Nephrocalcinosis and prematurity-is it time to change practice

Title: Nephrocalcinosos and prematurity -is it time to change practice?

Authors: Shah Sa , Quinn Da, Kilpatrick Sa, Joyce Eb, Lamont Vb, Reid Rb a: Craigavon Hospital Neonatal Unit Southern Health and Social Care Trust Northern Ireland b: Queens University Belfast fourth year Medical Students

Introduction

Preterm babies are at risk of nephrocalcinos (NC). This was first described by Hufnagle et al in 1982 1The prevalence of NC in preterm neonates in recent reports is 7–41%2

There are numerous causes for the development of NC in prematurity. Several early studies found furosemide therapy in chronic lung disease of prematurity was the most important etiological factor for NC1, 3, 4. Although spontaneous resolution of NC occurs in most children, some are at risk of renal damage later in life, validating the screening for NC of preterm neonates. Long-term follow-up of preterm neonates, especially with NC, is warranted.

Aims and objectives

To review current available literature on the causation and long term risks of NC in premature babies.

To ascertain current practice of diuretic therapy in premature babies with chronic lung disease across United Kingdom and explore reasons for variation in terms of choice of medication and duration of treatment.

Materials and Methods

We undertook a literature search on Medline to obtain all publications on NC in premature babies.

We approached British Association of Perinatal Medicine with predesigned proforma (appendix 1) requesting information about current practices across neonatal units in United Kingdom regarding long term diuretic therapy in premature babies treated for chronic lung disease.

We undertook a review of patients within our Neonatal Unit in the last 5 years with a diagnosis of NC to ascertain their current clinical status. Expert opinion from regional Paediatric Nephrology lead consultant was obtained.

All results were summarised and recommendations made.

References

1. Hufnagle KG, Khan SN, Penn D, et al. Renal calcifications: a complication of long term frusemide therapy. Paediatrics 1982; 70:360–3. 2. Eveline A. Schell-Feith & Joana E. Kist-van Holthe &Albert J. van der Heijden: Nephrocalcinosis in preterm neonates. Pediatr Nephrol (2010) 25:221–230 3. Jacinto JS, Modanlou HD, Crade M, Strauss AA, Bosu SK (1988)Renal calcification incidence in very low birth weight infants.Pediatrics 81:31–35 4. Pope JC 4th, Trusler LA, Klein AM,Walsh WF, Yared A, Brock JW3rd (1996) The natural history of nephrocalcinosis in premature infants treated with loop diuretics. J Urol 156:709–712

1 Nephrocalcinosis and prematurity-is it time to change practice

Appendix 1 : questionnaire

1. Do you use chronic ( more than 3 weeks) diuretic therapy to treat chronic lung disease in premature babies?

Yes/ No

Comments:

2. If yes to the above question what is the choice of diuretic used?

Furosemide with spironolactone :

Hydrochlorthiazide alone

Hydrochlorthiazide with Spirinolactone

3. Would you actively screen premature babies for Nephrocalcinosis?

Yes/No

Thank you

2 Nephrocalcinosis and prematurity-is it time to change practice