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

Shahirose S Premji; Majeeda Kamaluddeen

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

Future Perspective

As our understanding of the natural history of neonatal nephrocalcinosis increases, we will be able to identify those infants at higher risk of sequelae secondary to neonatal nephrocalcinosis and monitor them more closely. Furthermore, with advances in neonatal care, it will be possible for healthcare professionals to tailor care to the unique needs of each infant and minimize risk of adverse consequences of being born premature. For example, significant advancements in nutrition management may permit titrating total parental nutrition to minimize risk of developing hypercalciuria. As there is a paucity of literature to determine whether the calcium:creatinine ratio is a recognizable latent or early symptomatic stage, more research needs to be carried out in this area.

As technology advances it may be feasible to identify a gold-standard method to detect the very early stages of nephrocalcinosis and assess the extent of disease. Future research in this area should prioritize identification of a classification system, which will predict resolution of nephrocalcinosis.

Currently, effective and safe options to prevent or treat nephrocalcinosis in premature infants are limited. Although we can draw inferences from our experiences with pediatric patients, it is imperative that rigorous clinical trials be undertaken in the premature infant population as their capacity to metabolize and eliminate drugs is unique.

When answering the question, 'Should preterm infants be screened for nephrocalcinosis?' a screening program should have proven benefits with minimal harm, since most infants would not progress to clinically important disease (i.e., they demonstrate resolution). Furthermore, decisions need to be made in the context of burden on the healthcare system and families.

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

Next Section

Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.

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

Future Perspective

Tables

Tables

References

Authors and Disclosures

Authors and Disclosures

Sidebar

Sidebar

Executive Summary

Comments

Email This

Feedback

Confirm

Update