title: Variation in Practice Patterns for the Management of Newborn Spina Bifida in the United States.
abstract: OBJECTIVE
  To survey variations in recommended initial management of newborn spina bifida (SB).
  
  
  METHODS
  Members of an international pediatric urology ListServe and of the Pediatric Urology Nurse Specialists organization were surveyed on practice patterns for newborn SB. Pediatric urologists, nurse practitioners, and physician assistants practicing in the United States were included.
  
  
  RESULTS
  A total of 63 practitioners (48% pediatric urologists and 52% nurse practitioners or physician assistants) were included. Most practice at tertiary hospitals (94%) and about half use a protocol (56%). Recommended in-hospital screening tests include renal ultrasound (95%), voiding cystourethrogram (52%), catheterized bladder volumes (56%), and renal function tests (37%). Urodynamics are deferred until follow-up by 71%. Fifty percent of practitioners initiate clean intermittent catheterization (CIC) on all newborns, whereas 43% wait for symptoms. The majority of those who start CIC continue until residual volumes are below a threshold. Few recommend prophylactic antibiotics routinely (13%), or in patients on CIC (19%), but most recommend it for urinary reflux (62% grades 1-2, 79% grade 3, and 87% grades 4-5). Anticholinergics are deferred until after urodynamics (68%). Practicing at an institution with a pediatric urology fellowship program or an SB treatment protocol was associated with differing diagnostic work-up and urologic management.
  
  
  CONCLUSIONS
  There is variability in management of newborn SB among pediatric urology providers at tertiary care centers that may be influenced by institutional factors such as the presence of a pediatric urology fellowship or the presence of a protocol to care. This highlights the need for prospective multicenter projects to better understand how variations in management affect patient outcomes.
authors: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors: Daniel
authors: D
authors: Lodwick
authors: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors: Lindsey
authors: L
authors: Asti
authors: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors: Katherine
authors: K
authors: Deans
authors: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors: Peter
authors: P
authors: Minneci
authors: Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Section of Pediatric Urology, Nationwide Children's Hospital, Columbus, OH. Electronic address: daryl.mcleod@nationwidechildrens.org.
authors: Daryl
authors: D
authors: McLeod
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000627:therapeutic use; D002985:Clinical Protocols; D006801:Humans; D007231:Infant, Newborn; D057928:Intermittent Urethral Catheterization; D010818:Practice Patterns, Physicians'; D016135:Spinal Dysraphism / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires; D014481:United States; D014563:Urodynamics
chemical_list: D000900:Anti-Bacterial Agents; D018680:Cholinergic Antagonists