Table 2.
Practice patterns and factors influencing use of prophylactic antibiotics and referral to specialists. Question and answer wording replicate the administered survey.
| How frequently do you treat new cases of prenatal hydronephrosis? | No. of subjects(%)a |
|---|---|
| Monthly (>12 per year) | 24(10.1) |
| Every other month (6–11 per year) | 34(14.4) |
| Once in a while (2–5 per year) | 128(54.0) |
| Less than once a year | 51(21.5) |
| Do you initiate work-up or management of prenatal hydronephrosis by ordering tests through your office after the baby is born? | |
| Yes | 136(56.7) |
| Depends | 69(28.8) |
| No, I prefer the specialists to order their own studies | 32(13.2) |
| No, I neither order my own studies nor refer to a specialist | 3(1.24) |
| When an infant known to have PRENATAL hydronephrosis is born, what is/are your initial management step(s)? (check all that apply) | |
| Order investigational studies | 177(73.4) |
| Refer to urologist | 75(31.1) |
| Start antibiotics | 38(15.8) |
| Refer to nephrologist | 28(11.6) |
| Other | 27(11.2) |
| Do nothing if the child is otherwise doing well | 15(6.2) |
| In infants confirmed to have persistent hydronephrosis on postnatal ultrasound and has not yet seen a specialist, do you prescribe prophylactic antibiotics? | |
| Always | 70(29.3) |
| Usually | 65(27.2) |
| Rarely | 58(24.3) |
| Never | 46(19.3) |
| In those who answered “never”: | |
| Reasons FOR NOT prescribing prophylactic antibiotics. (check all that apply) | |
| I prefer a specialist to make that decision | 26(56.5) |
| I do not think it is indicated based on studies | 20(43.5) |
| I was not aware that antibiotics are indicated or a topic of debate | 14(30.4) |
| I am worried about the development of antibiotic resistance | 12(26.1) |
| Other | 7(15.2) |
| In those who answered “Always”, “Usually”, “Rarely”: | |
| Reasons FOR prescribing prophylactic antibiotics. (check all that apply) | |
| Prevent urinary tract infection | 141(73.1) |
| Awaiting more extensive work-up or specialist consultation | 109(56.5) |
| This is the way I was trained | 57(29.5) |
| Standard of care in my community | 49(25.4) |
| Young infants are more likely to have infections | 28(14.5) |
| Medico-legal protection | 23(11.9) |
| Other | 17(8.8) |
| Reassures parents | 7(3.6) |
| In those who answered “Usually”, “Rarely” or “Never”: | |
| Which of the following clinical situations might cause you to prescribe prophylactic antibiotics? (check all that apply) | |
| Specialist recommends it | 133(78.7) |
| History of UTI | 116(68.6) |
| Severe hydronephrosis | 97(57.4) |
| Solitary kidney with hydronephrosis | 68(40.2) |
| Bilateral hydronephrosis | 44(26.0) |
| Elevated baseline creatinine | 27(16.0) |
| Uncircumcised boy | 16(9.5) |
| Vesicoureteral reflux | 9 (7.8) |
| Other | 2(1.2) |
| Which of the following would influence your decision to refer to a specialist? (check all that apply) | |
| Severe hydronephrosis | 162(69.5) |
| Solitary kidney | 147(63.1) |
| Vesicoureteral reflux diagnosis | 134(57.5) |
| Elevated creatinine | 132(56.7) |
| I always refer to a specialist | 96(41.2) |
| Other | 18(7.7) |
a
Total n may sum to greater than 244 as questions instructing “check all that apply” permitted more than one response. Total n in all other questions may not sum to 244 as all subjects did not answer all questions.