Should We Screen Preterm Infants for Nephrocalcinosis? An Evidence-based Decision

Shahirose S Premji; Majeeda Kamaluddeen

Pediatr Health. 2010;4(1):24-35.

Conclusion

Improvements in diagnostic technology may increase our ability to identify nephrocalcinosis and thus can be viewed as beneficial. However, most cases of nephrocalcinosis will resolve spontaneously with time. Consequently, harm may not be averted because of screening and the intent of the screening to improve health outcomes of premature infants may not be realized. Although, the etiology of nephrocalcinosis is multifactorial^[6,16,17] and this creates challenges in differentially identifying the underlying cause of nephrocalcinosis and treating it effectively. The exact incidence of nephrocalcinosis is unknown and rates reported in the literature are estimates based on diagnosis confirmed by ultrasonography. The positive predictive value of a screening test is difficult to estimate if the prevalence of the disease in the population is not known.^[11] Furthermore, the health benefits of screening premature infants for nephrocalcinosis remains unknown given the uncertainty of the effectiveness of treatment and potential adverse effects of treatment. Given that most infants would not progress to clinically important disease (i.e., demonstrate resolution), treatments should be proven to be beneficial with minimal to no harm. Screening for nephrocalcinosis has the potential to harm by causing unnecessary parental/caregiver anxiety. Parents' perspective on screening program for nephrocalcinosis remains to be explored.

1 2 3 4 5 6 7 8 9 10 11 12 13

Next Section

Cite this: Should We Screen Preterm Infants for Nephrocalcinosis? An Evidence-based Decision - Medscape - Feb 01, 2010.

Table 1. Criterion for screening and appraisal based on available evidence.
Criteria for screening	Judgment: criteria met?			Level of evidence
Criteria for screening	Yes	Somewhat	No	1	2	3	4	5
The natural history of nephrocalcinosis is known and it is an important health problem?		×		×	×
Is there a suitable test to diagnose nephrocalcinosis?		×				×	×
Is there effective evidence-based treatment(s) for nephrocalcinosis? (e.g., citrate therapy for prevention)			×	×
Is there a recognizable latent or early symptomatic stage and does treatment in this phase lead to better outcomes?			×	×	×
Are there screening programs for nephrocalcinosis?	×							×

Table 2. Oxford Centre for Evidence-Based Medicine level of evidence guidelines.
Level	Types of studies
1	Systematic review of randomized controlled trials, inception cohort studies, level 1 diagnostic studies, or prospective cohort studies. Individual randomized controlled trial (with narrow confidence interval), cohort study with greater than 80% follow-up, validating cohort study with good reference standards, prospective cohort study with good follow-up.
2	Systematic review of cohort studies, retrospective cohort studies, untreated control groups in randomized controlled trials, or level greater than 2 diagnostic studies. Individual cohort study with less than 80% follow-up, retrospective cohort study or follow-up of untreated control patients in a randomized controlled trial, exploratory cohort study with good reference standards. Outcome research, ecological studies.
3	Systematic review of case–control studies, or nonconsecutive study. Individual case–control study, nonconsecutive study or without consistently applied reference standards, or very limited population.
4	Case-series (and poor quality cohort and case–control studies or prognostic cohort studies), case–control study, poor or nonindependent reference standard.
5	Expert opinion without explicit critical appraisal, or based on physiology, bench research or 'first principle'.

Adapted with permission from ^[102].

Comments

Commenting is limited to medical professionals. To comment please Log-in.

Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.

processing....

Should We Screen Preterm Infants for Nephrocalcinosis? An Evidence-based Decision

Conclusion

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

Sidebar

Sidebar

Executive Summary

Comments

Email This

Feedback

Confirm

Update