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

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.

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