Newborn with PUV

So once we have a baby that's born with postnatal valves, what is the next step? So here we would transfer the baby from the birth hospital to the intensive care unit. And um uh from a urology standpoint, we just need to decompress the bladder with a feeding tube, and that takes the pressure out of the system, reduces the risk of infections, allows the neonatologist then to go ahead and focus on the rest of the health of the baby, making sure the baby's lungs are working. Um, sometimes we do have to put the baby on a ventilator, and then we're going to see what's going on from an overall health standpoint for the baby, examine the baby, see if there are any other congenital malformations. And then putting the whole team of experts together to understand what is the care plan for that baby, discuss it with the family, counsel the family about what are the next steps involved. If the baby is not making urine or if the baby's lab tests are showing that the baby's kidneys are not working well, Doctor Clayson and her colleagues from nephrology would then again rediscuss the possibility of dialysis, if that's the right thing for the baby and make sure the family understands that that is a path that they can take, but it's a very extensive, very hands-on. Um, care plan that has to be executed for the baby and it requires a great deal of commitment from the families and their care and their support group. When the baby is stable, we will take the baby to the operating room and incise the valves, cut the valves surgically so that they are no longer obstructing. Very important to understand, just because we cut the valves doesn't revert everything back to normal. Unfortunately, the damage to the bladder, damage to the kidney, potential damage to the lungs might be permanent. So for the remainder of the baby's life, we are going to be monitoring their kidney function, their bladder function, and overall health very, very carefully. And the goals of management of a child with post fetal valves at that point when they are stabilized, we've incised the valves is to protect the kidneys. To protect the bladder from incomplete emptying or infections and make sure that the bladder can store urine at very, very low pressures. We want to minimize the risk of infections by ensuring the bladder empties really well at an age appropriate time, we want to ensure that the baby is able to get toilet control and bladder trained. And then really importantly, working with our nephrology colleagues monitor the kidney function so as the child grows, make sure that the kidney function is staying and keeping up with what the child's bodies require. Our eventual goal is to permit independent care for whatever care the child may require that they can do it for themselves and also ensure that the child has an appropriate psychosocial body image of themselves.