Clinical Pathway for the Care of the Neonate with Myelomeningocele/Myeloschisis

Urology Issues for Infants with Pre-Natal or Post-Natal Repair

Goal: Evaluate for neurogenic bladder and to preserve renal function

Spina bifida is the most common cause of a neurogenic bladder in children. Early management is critical in order to reduce the chances they will need surgical intervention.

Symptoms of neurogenic bladder may include:

Urine leakage Vesicoureteral reflux (VUR)
Urine retention Urinary tract infection
Hydronephrosis Kidney stones

  PRE-NATAL REPAIR POST-NATAL REPAIR
Bladder Scans
  • Perform on admission
  • Continue every 4 hours for 48 hours
  • If volumes remain < 2 x predicted capacity 48 hrs it is usually safe to discontinue
Perform on admission
Post-op:
  • Correlate first 3 post-operative bladder scan volumes with CIC
  • If similar low volumes, may discontinue CIC
  • Continue bladder scans every 4 hours for 48 hours post-op
  • If volumes remain <2 x predicted capacity after 48 hrs it usually safe to discontinue
Clean Intermittent Cath (CIC) Convert to CIC:
  • Bladder scan is > than 2x predicted bladder capacity on > 2 occasions
Perform CIC every 4 hours when clinically indicated

A 2x predicted bladder capacity that is seen on several bladder scans is a fairly good predictor that the infant has spinal shock and an areflexic bladder.
  • Perform every 4 hours if clinically indicated
  • Discontinue only after Urology approval
Weaning CIC
  • Gradually increase the amount of time between CIC
  • Monitoring bladder scan volumes
  • Work with urology to find a safe schedule
 

Determining Bladder Capacity

Approximately 7 mL/kg (e.g. 4 kg infant, approximately 30 mL)

If Bladder scan

≥ 2 x calculated bladder capacity Perform CIC
< 2 x calculated bladder capacity Continue with bladder scans as ordered