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

Shahirose S Premji; Majeeda Kamaluddeen

Disclosures

Pediatr Health. 2010;4(1):24-35. 

In This Article

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.

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