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Birth defects and other problems of the urinary tract may be
discovered before the baby is born, at the time of birth, or later, when the
child is brought to the doctor for a urinary tract infection or urination
Tests during pregnancy can help determine if the baby is
developing normally in the womb.
Ultrasound. Ultrasound uses sound waves to produce a picture on a television
screen. A wand gliding on the mother's abdomen directs harmless sound waves into
the womb. The sound waves bounce off the baby and back into the wand to create a
black-and-white image on the screen. Ultrasound images can even display internal
organs within the baby, so enlarged kidneys, ureters, or bladder may be visible.
Amniocentesis. In amniocentesis, the doctor inserts a needle through the
mother's skin into the amniotic sac to collect about an ounce of amniotic fluid.
The fluid contains genetic material from the baby that can be analyzed for signs
Chorionic villus sampling (CVS). In CVS, the doctor collects a small piece
of tissue from the placenta using a needle passed through the mother's vagina
and cervix. The placenta has the same genetic makeup as the baby.
Most healthy women do not need all the tests. Ultrasound examinations during
pregnancy are routine, although they are not always required and rarely
influence treatment decisions. Amniocentesis and CVS are recommended only when a
risk of genetic problems exists because of family history or something detected
during an ultrasound. Amniocentesis and CVS carry a slight risk of harming the
baby and mother, or ending the pregnancy in miscarriage, so those risks should
be weighed carefully against the potential benefits of learning about the baby's
Examination of Newborn
Sometimes a newborn does not urinate as
expected, even though prenatal testing showed no sign of urine blockage. The
baby may urinate only small amounts or not at all. An enlarged kidney may be
felt during the newborn examination as well. Different imaging techniques are
available to determine the cause of the problem.
Ultrasound. Once the baby is born, ultrasound can be used to view the baby's
urinary tract directly for a clearer image than could be achieved while the baby
was in the womb.
Voiding cystourethrogram (VCUG). If the doctor suspects that urine is
backing up into the ureters or that the bladder outlet is obstructed, a VCUG may
be needed. In this test, a catheter is used to fill the child's bladder with
warm liquid containing iodine to make it visible on an x ray. A video records
the x-ray images of the bladder as it is filled and as the child urinates. The
video will reveal reflux if the liquid enters the ureters and blockage of the
bladder in the case of an obstruction, such as PUV.
Nuclear scan. A nuclear scan involves injecting a very small amount of
radioactive material, just enough to show up using a camera that captures gamma
rays. The amount of radioactive substance used is determined by the child's
weight. The liquid is injected into the child's bloodstream and eventually
passes through the kidneys, where it is filtered from the blood and directed
down the ureters to the bladder. The camera may be mounted above or below a
table where the patient lies. The camera passes over or under the urinary tract
as the child lies on the table.
Sometimes urine blockage is not
apparent until the child develops the symptoms of a urinary tract infection.
These symptoms include
unusual smelling urine
If these symptoms persist, the child should be seen by a doctor. For any
fever in the first 2 months of life, the child should be seen by a doctor
immediately. The doctor will ask for a urine sample to test for bacteria. The
doctor may also recommend imaging tests including ultrasound, VCUG, or nuclear