Neonate: Myelomeningocele/Myeloschisis — Urology Issues for Infants with Pre or Postnatal Closure — Clinical Pathway: ICU

Neonatal Myelomeningocele/Myeloschisis Clinical Pathway — ICU

Urology Issues for Infants with Prenatal or Postnatal Closure

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 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
  Prenatal Repair Postnatal Repair
Bladder Scans
  • Perform on admission
  • Continue every 4 hours for 48 hours
  • If volumes remain < 1.5 x predicted capacity for 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 < 1.5 x predicted capacity for 48 hrs it usually safe to discontinue
Clean Intermittent Cath (CIC) and Weaning CIC
  • Convert to CIC:
    • CIC should be performed if bladder scan is > 1.5 x predicted bladder capacity on more than one occasion
  • Perform CIC every 4 hours when clinically indicated
  • A > 1.5 x predicted bladder capacity seen on several bladder scans is a fairly good predictor that the infant has spinal shock and an areflexic bladder.

Determining Bladder Capacity

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

If Bladder scan

≥ 1.5 x calculated bladder capacity Perform CIC
< 1.5 x calculated bladder capacity Continue with bladder scans as ordered

CIC

Sterile technique in hospital

Clean technique at home