vesicoureteral reflux

Let me dive a little bit deeper.

A lot of people use the renal bladder ultrasound or thought that a normal renal bladder ultrasound meant that that child who had a UTI doesn't have vesicular ureteral reflux and therefore not having VUR, I'll call it VUR, meant that that normal bladder ultrasound meant they didn't have VUR and they were done and there was nothing else to do.

Really, the sensitivity, and we get into this in the guidelines, the sensitivity to pick up would be imaging findings consistent with VUR.

The ultrasound is really poor at doing that as a screening tool, so sensitivity is very low.

What we're really looking for with the renal bladder ultrasound is to look for structural abnormalities or things that might, if missed, like a severe obstruction, might put that kid at risk for a really severe UTI down the road.

But, you know, the key action statement around continuous antibiotic prophylaxis really applies to low-risk vesicle ureteral reflux.

Okay.

We basically say low-risk VUR is defined as lower grade, grade one or two, and no bowel and bladder dysfunction.

So again, uh, this, uh, pertains to the key action for, uh, recommending against routine VCUG after a first febrile UTI in children younger than five who have normal renal bladder ultrasounds and none of those additional conditions which we spoke about Uh, six.

In children then with low risk VUR, the guideline panel suggests against using routine, uh, continuous antibiotic prophylaxis, uh, CAP.

Um, again, a conditional recommendation.

So they define low risk as a child having lower grade VUR, uh, one to two, that's what low grade by definition, and no presence of bowel and bladder dysfunction.

So I think this is an important piece in some of our old, not, not maybe our NICU babies, but we've all experienced a child like this, some in our own [laughs] families.

Um, dysfunctional constipation, uh, is excluded, but anybody having presence of bowel and bladder dysfunction, um, uh, would not be defined as low risk.

So they must have a low-grade VUR and no presence of bowel or bladder dysfunction.

Okay.

So again, uh, this, uh, pertains to the key action for, uh, recommending against routine VCUG after a first febrile UTI in children younger than five who have normal renal bladder ultrasounds and none of those additional conditions which we spoke about.

Uh, six in children then with low risk VUR, the guideline panel suggests against using routine, uh, continuous antibiotic prophylaxis, uh, CAP, um, again, a conditional recommendation.

So they define low risk as a child having lower grade VUR, uh, one to two, that's what low grade by definition, and no presence of bowel and bladder dysfunction.

So I think this is an important piece in some of our old... not, not maybe our NICU babies, but we've all experienced a child like this, some in our own [laughs] families.

Um, dysfunctional constipation, uh, is excluded, but anybody having presence of bowel and bladder dysfunction, um, uh, would not be defined as low risk.

So they must have a low-grade VUR and no presence of bowel or bladder dysfunction.

Okay.

Okay.

As far as other things, there are sort of two other things I was going to pull up.

The routine continuous antibiotic prophylaxis is not recommended for children with milder forms of vesicoureteral reflux, sorry, VUR, while awaiting urology referral.

And they also put some heavy emphasis on the need to also treat bowel and bladder dysfunction in children and infants with UTI.

They have some really nice flow diagrams, which I realize I didn't clip in here, but you can freely access the paper online and take a look at those.