A 12 hour old baby has not urinated over 12 hrs. The nursing team noted swelling below the umbilical clamp and removed the clamp. You were called to look at the umbilicus. What is the best next step in management of this patient?

 

 

a Laparoscopy

 

b Ultrasound

 

c Umbilical exploration

 

d Function excretion of NA (FeNa)

 

e Fluid bolus

b

B

A 12 hour old baby has not urinated over 12 hrs. The nursing team noted swelling below the umbilical clamp and removed the clamp. You were called to look at the umbilicus. What is the best next step in management of this patient?

 

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a Laparoscopy

 

b Ultrasound

 

c Umbilical exploration

 

d Function excretion of NA (FeNa)

 

e Fluid bolus

B

B

B

B

correct answer

b Ultrasound

 

The stream of urine from the umbilicus is highly suggestive of an urachal remnant. Since the baby has not voided for several hours, there should be concern for posterior urethral valves. The first study should be an abdomen pelvic ultrasound to look at the kidneys (which would show hydronephrosis) and the bladder (enlarged).

 

For urachal remnants that are not connected to lower urinary tract obstruction, an open or laparoscopic exploration would be appropriate for definitive surgical management. Some authors have described closure simply with a foley placement. FeNa would help distinguish prerenal and renal causes of renal failure and would not be appropriate in this case. A fluid bolus would not be appropriate as the baby appears to be urinating at this time.