Abstract：
BACKGROUND: The management of posterior urethral valve (PUV) in neonates requires close monitoring in the intensive care unit because of the risk of post-obstructive diuresis (POD). Our aim was to describe the incidence and factors associated with POD in newborns treated for PUV.
METHODS: Retrospective analysis of the medical records of all neonates who underwent surgical intervention for PUV in our neonatal intensive care unit between January 2014 and April 2021.
RESULTS: Of the 40 patients included, 15 (37.5%) had POD defined by urine output > 6 ml.kg-1.h-1 during the first 24 h following urinary tract obstruction relief. At prenatal ultrasound examinations, oligohydramnios was more common in the group with POD than in the group without (53.3% vs. 8%, p = 0.002). Preterm birth was more frequent in neonates with POD (66.7% vs. 8%; p < 0.001). Median serum creatinine (212 [137-246] vs. 95 [77-125] µmol.l-1; p < 0.001) and urea (8.5 [5.2-12.2] vs. 4.1 [3.5-4.7] mmol.l-1; p < 0.001) concentrations on the day of obstruction relief were significantly higher in the group with POD than in the group without. After adjustment for prematurity, logistic regression models confirmed correlation between the occurrence of POD and the severity of the consequences of urethral obstruction (i.e., oligohydramnios and serum creatinine levels; ß = 2.90 [0.88; 5.36], p = 0.013 and ß = 0.014 [0.003; 0.031], p = 0.034, respectively).
CONCLUSIONS: In neonates, POD is common after the relief of PUV-related obstruction. Our findings may help to identify patients at highest risk. A higher resolution version of the Graphical abstract is available as Supplementary information.
METHODS: Retrospective analysis of the medical records of all neonates who underwent surgical intervention for PUV in our neonatal intensive care unit between January 2014 and April 2021.
RESULTS: Of the 40 patients included, 15 (37.5%) had POD defined by urine output > 6 ml.kg-1.h-1 during the first 24 h following urinary tract obstruction relief. At prenatal ultrasound examinations, oligohydramnios was more common in the group with POD than in the group without (53.3% vs. 8%, p = 0.002). Preterm birth was more frequent in neonates with POD (66.7% vs. 8%; p < 0.001). Median serum creatinine (212 [137-246] vs. 95 [77-125] µmol.l-1; p < 0.001) and urea (8.5 [5.2-12.2] vs. 4.1 [3.5-4.7] mmol.l-1; p < 0.001) concentrations on the day of obstruction relief were significantly higher in the group with POD than in the group without. After adjustment for prematurity, logistic regression models confirmed correlation between the occurrence of POD and the severity of the consequences of urethral obstruction (i.e., oligohydramnios and serum creatinine levels; ß = 2.90 [0.88; 5.36], p = 0.013 and ß = 0.014 [0.003; 0.031], p = 0.034, respectively).
CONCLUSIONS: In neonates, POD is common after the relief of PUV-related obstruction. Our findings may help to identify patients at highest risk. A higher resolution version of the Graphical abstract is available as Supplementary information.
摘要：
背景：新生儿后尿道瓣膜（PUV）的管理需要在重症监护病房进行密切监测，因为存在梗阻性利尿（POD）的风险。我们的目的是描述接受PUV治疗的新生儿POD的发生率和相关因素。
方法：回顾性分析2014年1月至2021年4月在我们的新生儿重症监护病房接受PUV手术干预的所有新生儿的病历。
结果：纳入的40例患者中，15（37.5％）的POD定义为尿量>6ml。kg-1.在尿路梗阻缓解后的第一个24小时内h-1。在产前超声检查中，羊水过少在POD组比无POD组更常见(53.3%vs.8%,p=0.002)。POD新生儿的早产发生率更高（66.7％vs.8%；p<0.001)。血清肌酐中位数（212[137-246]vs.95[77-125]μmol。l-1；p<0.001）和尿素（8.5[5.2-12.2]vs.4.1[3.5-4.7]mmol。l-1;p<0.001）在阻塞缓解当天的浓度在POD组中明显高于无阻塞组。在对早产进行调整后，logistic回归模型证实了POD的发生与尿道梗阻后果的严重程度之间的相关性(即，羊水过少和血清肌酐水平；β=2.90[0.88;5.36]，p=0.013和β=0.014[0.003;0.031]，分别为p=0.034)。
结论：在新生儿中，POD在缓解PUV相关梗阻后很常见。我们的发现可能有助于识别风险最高的患者。更高分辨率版本的图形摘要可作为补充信息。
方法：回顾性分析2014年1月至2021年4月在我们的新生儿重症监护病房接受PUV手术干预的所有新生儿的病历。
结果：纳入的40例患者中，15（37.5％）的POD定义为尿量>6ml。kg-1.在尿路梗阻缓解后的第一个24小时内h-1。在产前超声检查中，羊水过少在POD组比无POD组更常见(53.3%vs.8%,p=0.002)。POD新生儿的早产发生率更高（66.7％vs.8%；p<0.001)。血清肌酐中位数（212[137-246]vs.95[77-125]μmol。l-1；p<0.001）和尿素（8.5[5.2-12.2]vs.4.1[3.5-4.7]mmol。l-1;p<0.001）在阻塞缓解当天的浓度在POD组中明显高于无阻塞组。在对早产进行调整后，logistic回归模型证实了POD的发生与尿道梗阻后果的严重程度之间的相关性(即，羊水过少和血清肌酐水平；β=2.90[0.88;5.36]，p=0.013和β=0.014[0.003;0.031]，分别为p=0.034)。
结论：在新生儿中，POD在缓解PUV相关梗阻后很常见。我们的发现可能有助于识别风险最高的患者。更高分辨率版本的图形摘要可作为补充信息。
