OpenHealth Q&A

Navigating the Path Forward with Newborn Hydronephrosis

I'm seeking sincere and practical insights regarding the various risks associated with the circumstances we are currently encountering. At 37 weeks along with my pregnancy, I am expecting a son. At 30 years old, I'm married and maintain good health, free from any medications or prior health concerns. I neither smoke, drink, nor vape, and my pregnancy has been relatively smooth apart from this recent finding. This is my third pregnancy overall, and I have one living child. I previously experienced a spontaneous early miscarriage last November, which did not necessitate any medical intervention. Now, to the matter at hand— During an ultrasound at 34 weeks and one day, an enlargement of the baby's right kidney was detected, measuring 9mm and diagnosed as mild pyelectasis. Consequently, I was referred to Maternal-Fetal Medicine (MFM). At 37 weeks and one day, MFM conducted another anatomy ultrasound. By this time, both the right kidney and ureter were noted to be enlarged, specifically the kidney at 8.1mm, and classified as moderate to severe pyelectasis. Following this, I had an appointment with a urologist at 37 weeks and three days. He assessed the condition as moderate hydronephrosis and proposed the following recommendations: - Circumcision (which we strongly oppose based on our beliefs). - Commence a low dose of amoxicillin immediately after birth, until it is confirmed that there is no reflux, or the issue resolves on its own if it is reflux. - An ultrasound scheduled 48 hours post-delivery. - Should hydronephrosis still be detected (something the urologist anticipates), a return visit to urology will be necessary to check for reflux. - If reflux isn't the problem, around one month after birth, a test will be needed to see if there’s an obstruction in the urinary tract. Alternatively, if we choose to forgo these procedures and prefer a more observational approach, the urologist mentioned that regular ultrasounds would be conducted. However, he noted that the risk of developing a urinary tract infection (UTI) is “high,” though he did not clarify what that meant. I am apprehensive about placing my newborn on continuous antibiotics for a potential UTI that may or may not materialize. When I pressed him about the risks associated with the antibiotics, he claimed there were none, which I find hard to accept as an absolute truth. What are the actual risks associated with administering long-term low-dose amoxicillin to newborns? What is the likelihood of my baby developing a UTI? How dangerous is the wait-and-see strategy? Am I overreacting by perceiving this situation as overly serious? I prefer to pursue the least invasive options available—avoiding antibiotics and unnecessary tests aside from ultrasounds, given that this condition might resolve itself. Learning of this issue just three weeks before my due date has left me feeling overwhelmed, as I grapple with the significant decision between using long-term antibiotics or exposing my baby to the risk of infection. Any advice would be immensely helpful as I navigate this challenging situation.

Answers (1)

9/11/2025, 5:50:52 PM

OpenHealth AI

It sounds like you are navigating a challenging situation with your newborn's diagnosis of moderate hydronephrosis and considering different approaches for managing it. It's completely understandable to feel overwhelmed, especially this close to your due date. Here’s a summary of the key points, followed by an explanation and prioritized next steps.

Key Points:

1. Hydronephrosis in Newborns: This condition may resolve on its own but requires monitoring due to potential complications like urinary tract infections (UTIs).
2. Antibiotics Concerns: Long-term use of antibiotics carries risks, but these must be balanced against the risk of UTI and its possible complications.
3. Monitoring vs. Intervention: A watchful waiting approach is valid, especially if you prefer to avoid invasive procedures.

Explanation:

Hydronephrosis in infants can be caused by various factors, including urinary obstruction or reflux, and often resolves as the child grows. The concerns about UTI arise because hydronephrosis may lead to an increased risk of infection in the urinary tract, which can potentially escalate into more serious health issues if not monitored.

Antibiotics such as amoxicillin are used prophylactically to prevent UTIs, especially if reflux is suspected. While antibiotics are generally safe, long-term use can lead to side effects, including:

• Alteration of gut flora (which may affect digestion).
• Allergic reactions (though rare).
• Development of antibiotic-resistant bacteria, which could complicate future treatments.

Next Steps:

1. Monitor Symptoms: After birth, closely monitor your newborn for signs of infection, including fever, irritability, and changes in feeding patterns. Share any concerns with your pediatrician immediately.

2. Consider Scheduled Follow-Ups: Plan for regular ultrasounds as suggested; this non-invasive approach can provide insight into whether the hydronephrosis is improving or requires further investigation.

3. Discuss Alternatives: If UTI risk is a concern, ask your healthcare team about alternative strategies to manage potential UTIs without immediate antibiotic treatment. Depending on your baby's situation, they may recommend a "watchful waiting" plan where close observation is balanced with timely interventions if needed.

4. Educate Yourself: Seek reliable resources on hydronephrosis and UTI risks in infants. Understanding the condition better can help alleviate some concerns.

5. Communicate Concerns: Ensure you have open communication channels with your healthcare team. Don’t hesitate to bring up any specific fears about antibiotic use or the necessity of interventions. They should provide clarity and reassurance based on the latest evidence and your family’s unique values.

Your feelings are valid, and navigating this may take both patience and trust in your healthcare team. Remember, focusing on your baby's well-being and keeping engaged with health professionals will help navigate this phase effectively. Let me know if you have any other questions or need further clarity!