A multinational survey on the management of the urinary tract in newborns with spina bifida: Are we following current EAU/ESPU guidelines?

AIMS: In August 2019, the European Association of Urology (EAU) and European Society for Paediatric Urology (ESPU) published updated guidelines on the management of neurogenic bladder in children and adolescents. Our study aimed to establish whether members of the ESPU are adhering to these guidelines. METHODS: We designed a survey comprising 26 questions using SurveyMonkey®. Respondents were asked about management of neurogenic bladder at birth in newborns with spina bifida (SB), urological investigations, as well as short and long-term follow-up in their institutions. RESULTS: There were 103 respondents to the survey (754 recipients, giving a response rate of 14%) spanning 36 countries. 100% of respondents carry out a renal/bladder ultrasound at birth. Only 53% routinely commence clean intermittent catheterization soon after birth as recommended by the guidelines. Only 56% recommend anticholinergic medications after abnormal videourodynamics (VUDs). The guidelines recommend the use of continued antibiotic prophylaxis if there is evidence of vesicoureteral reflux and hostile bladder/non-conclusive results on VUDs which is followed by only 30% of providers. 63% of respondents carry out baseline VUDs at the recommended time. Seeing larger volumes of SB patients, having a formal SB protocol, having formal SB multidisciplinary clinics and working in a tertiary referral center did not make respondents more likely to adhere to guidelines. CONCLUSIONS: Our survey demonstrated that large variations from the EAU/ESPU guidelines exist in practice. The study confirms that further work is required across institutions and countries to implement these evidence-based recommendations for standardized practice.

Comparison of midwife-led and consultant-led care of healthy women at low risk of childbirth complications in the Republic of Ireland: a randomised trial.

BACKGROUND: No midwifery-led units existed in Ireland before 2004. The aim of this study was to compare midwife-led (MLU) versus consultant-led (CLU) care for healthy, pregnant women without risk factors for labour and delivery. METHODS: An unblinded, pragmatic randomised trial was designed, funded by the Health Service Executive (Dublin North-East). Following ethical approval, all women booking prior to 24 weeks of pregnancy at two maternity hospitals with 1,300-3,200 births annually in Ireland were assessed for trial eligibility.1,653 consenting women were centrally randomised on a 2:1 ratio to MLU or CLU care, (1101:552). 'Intention-to-treat' analysis was used to compare 9 key neonatal and maternal outcomes. RESULTS: No statistically significant difference was found between MLU and CLU in the seven key outcomes: caesarean birth (163 [14.8%] vs 84 [15.2%]; relative risk (RR) 0.97 [95% CI 0.76 to 1.24]), induction (248 [22.5%] vs 138 [25.0%]; RR 0.90 [0.75 to 1.08]), episiotomy (126 [11.4%] vs 68 [12.3%]; RR 0.93 [0.70 to 1.23]), instrumental birth (139 [12.6%] vs 79 [14.3%]; RR 0.88 [0.68 to 1.14]), Apgar scores < 8 (10 [0.9%] vs 9 [1.6%]; RR 0.56 [0.23 to 1.36]), postpartum haemorrhage (144 [13.1%] vs 75 [13.6%]; RR 0.96 [0.74 to 1.25]); breastfeeding initiation (616 [55.9%] vs 317 [57.4%]; RR 0.97 [0.89 to 1.06]). MLU women were significantly less likely to have continuous electronic fetal monitoring (397 [36.1%] vs 313 [56.7%]; RR 0.64 [0.57 to 0.71]), or augmentation of labour (436 [39.6%] vs 314 [56.9%]; RR 0.50 [0.40 to 0.61]). CONCLUSIONS: Midwife-led care, as practised in this study, is as safe as consultant-led care and is associated with less intervention during labour and delivery.

Plastic particles in coastal pelagic ecosystems of the Northeast Pacific ocean.

The purpose of this study was to examine the distribution, abundance and characteristics of plastic particles in plankton samples collected routinely in Northeast Pacific ecosystems, and to contribute to the development of ideas for future research into the occurrence and impact of small plastic debris in marine pelagic ecosystems. Plastic debris particles were assessed from zooplankton samples collected as part of the National Oceanic and Atmospheric Administration's (NOAA) ongoing ecosystem surveys during two research cruises in the Southeast Bering Sea in the spring and fall of 2006 and four research cruises off the U.S. west coast (primarily off southern California) in spring, summer and fall of 2006, and in January of 2007. Nets with 0.505 mm mesh were used to collect surface samples during all cruises, and sub-surface samples during the four cruises off the west coast. The 595 plankton samples processed indicate that plastic particles are widely distributed in surface waters. The proportion of surface samples from each cruise that contained particles of plastic ranged from 8.75 to 84.0%, whereas particles were recorded in sub-surface samples from only one cruise (in 28.2% of the January 2007 samples). Spatial and temporal variability was apparent in the abundance and distribution of the plastic particles and mean standardized quantities varied among cruises with ranges of 0.004-0.19 particles/m³, and 0.014-0.209 mg dry mass/m³. Off southern California, quantities for the winter cruise were significantly higher, and for the spring cruise significantly lower than for the summer and fall surveys (surface data). Differences between surface particle concentrations and mass for the Bering Sea and California coast surveys were significant for pair-wise comparisons of the spring but not the fall cruises. The particles were assigned to three plastic product types: product fragments, fishing net and line fibers, and industrial pellets; and five size categories: <1 mm, 1-2.5 mm, >2.5-5 mm, >5-10 mm, and >10 mm. Product fragments accounted for the majority of the particles, and most were less than 2.5 mm in size. The ubiquity of such particles in the survey areas and predominance of sizes <2.5 mm implies persistence in these pelagic ecosystems as a result of continuous breakdown from larger plastic debris fragments, and widespread distribution by ocean currents. Detailed investigations of the trophic ecology of individual zooplankton species, and their encounter rates with various size ranges of plastic particles in the marine pelagic environment, are required in order to understand the potential for ingestion of such debris particles by these organisms. Ongoing plankton sampling programs by marine research institutes in large marine ecosystems are good potential sources of data for continued assessment of the abundance, distribution and potential impact of small plastic debris in productive coastal pelagic zones.