Urine Blockage in Newborns - Diagnosis

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Diagnosis

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 problem.

Prenatal Screening

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 of defects.


  • 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 condition.

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.

Later Diagnosis

Sometimes urine blockage is not apparent until the child develops the symptoms of a urinary tract infection. These symptoms include

  • fever


  • irritability


  • poor appetite


  • vomiting


  • unusual smelling urine


  • dark 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 scan.

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