ICU, Inpatient, Outpatient Specialty Care and Primary Care Clinical Pathway for Evaluation/Management of Neonates Presenting with Findings of Perinatal Urinary Tract Dilation

Goals and Metrics
Patients presenting with ultrasound findings of perinatal urinary tract dilation (UTD)
Initial Patient Assessment
PRENATAL Ultrasound Risk Stratification
for Postnatal Intervention
Low Risk (A1)
  • 16-27 weeks AP RPD 4 to 6.9 mm
  • OR
  • ≥ 28 weeks AP RPD 7 to < 10 mm
  • AND/OR
  • Central calyceal dilation with all other US findings normal
Increased Risk (A2-3)
  • 16-27 weeks AP RPD ≥ 7 mm
  • OR
  • ≥ 28 weeks AP RPD ≥ 10 mm
  • AND/OR
  • Any abnormal ultrasound finding (except central calyceal dilation)
Management Based on PRENATAL Ultrasound Risk Stratification

Obtain POSTNATAL US per recommendations

POSTNATAL Ultrasound Risk Stratification
Low Risk (P1)
  • AP RPD 10 to < 15 mm
  • AND/OR
  • Central calyceal dilation with all other US findings normal
Intermediate Risk (P2)
  • AP RPD ≥ 15 mm
  • AND/OR
  • Any of the following:
    • Peripheral calyceal dilation
    • Abnormal ureters
High Risk (P3)
  • AP RPD ≥ 15 mm
  • AND/OR
  • Any of the following:
    • Abnormal parenchymal thickness
    • Abnormal parenchymal appearance
    • Abnormal bladder
    • Abnormal urethra
Management based on POSTNATAL Ultrasound Risk Stratification
Legend
UTDUrinary tract dilation
AAntenatal
PPostnatal
AP RPDAnterior-posterior renal pelvic diameter
VCUGVoiding cystourethrogram
CeVUSContrast-enhanced voiding urosonography
RBUSRenal and bladder ultrasound
MAG 3Lasix (nuclear medicine) renal scan
fMRUFunctional MR urography
VURVesicoureteral reflux
UPJUreteropelvic junction
  • Ultrasound Findings of UTD
  • Central or peripheral calyceal dilation
  • Abnormal parenchymal thickness
  • Abnormal parenchymal appearance
  • Abnormal ureters
  • Abnormal bladder
  • Abnormal urethra

Discharge Planning Considerations

If ultrasound is obtained at outside hospital, obtain CD of images and bring to PCP and/or urology follow-up.

Reinforce importance of continued antibiotics (if prescribed) until follow-up with urology to avoid complications.

Inform family to refill and continue amoxicillin every 2 weeks until follow-up with PCP or urology.

CHOP Urology strongly recommends obtaining VCUG at CHOP to ensure reduced radiation exposure and quality images.

Do not discharge patient until imaging findings are resulted.

Call CHOP Urology with any questions at 215-590-2754.

Posted: May 2019
Revised: July 2020
Authors: D. Weiss, MD, K. Mckenna, MD, H. Otero, MD, D. Kaiser, CRNP, J. Ko, MD