Design and Methodological Considerations of the National Spina Bifida Patient Registry Urologic and Renal Protocol for the Newborn and Young Child

Routh, J. C.; Cheng, E. Y.; Austin, J. C.; Baum, M. A.; Gargollo, P. C.; Grady, R. W.; Herron, A. R.; Kim, S. S.; King, S. J.; Koh, C. J.; Paramsothy, P.; Raman, L.; Schechter, M. S.; Smith, K. A.; Tanaka, S. T.; Thibadeau, J. K.; Walker, W. O.; Wallis, M. C.; Wiener, J. S.; Joseph, D. B.

J Urol. 2016 Aug 1

Abstract

INTRODUCTION: Care of children with spina bifida (SB) has significantly advanced over the last half-century, resulting in gains in longevity and quality of life for affected children and caregivers. Bladder dysfunction is the norm in SB patients and may result in infection, renal scarring, and chronic kidney disease. However, the optimal urologic management for SB-related bladder dysfunction is unknown. METHODS: In 2012, Centers for Disease Control and Prevention (CDC) convened a working group composed of pediatric urologists, nephrologists, epidemiologists, methodologists, community advocates, and CDC personnel to develop a protocol to optimize urologic care of children with SB from the newborn period through 5 years of age. RESULTS: An iterative quality-improvement protocol was selected; in this model, participating institutions agree to prospectively treat all newborns with SB using a single consensus-based protocol. Over the course of the 5-year study period, study outcomes are routinely assessed and the protocol adjusted as needed in order to optimize patient and process outcomes. Primary study outcomes include urinary tract infections (UTI), renal scarring, renal function, and bladder characteristics. The protocol specifies the timing and use of testing (e.g., ultrasonography, urodynamics) and interventions (e.g., intermittent catheterization, prophylactic antibiotics, antimuscarinic medications). Starting in 2014, the CDC began funding nine study sites to implement and evaluate the protocol. CONCLUSIONS: The CDC Urologic and Renal Protocol for the Newborn and Young Child with Spina Bifida began accruing patients in 2015. Assessment in the first 5 years will focus on UTIs, renal function, renal scarring, and clinical process improvements.

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