Drew, J. H., and Acton, C. M. (1976). Archives of Disease in Childhood, 51, 628. Radiological findings In newborn infants with urinary infections. Selective suprapubic urine aspiration was performed in 905 of 12 942 consecutive live-born infants and showed the presence of infection in 64 (0°5%). A majority (84%) of the infected infants were males. Radiological abnormalities were detected in 35 (55 %). Because of this high incidence of abnormalities, which when diagnosed might alter management, it is suggested that radiological investigations be performed in newborn infants with proven urinary infection.The epidemiology of urinary tract infection in schoolchildren is known (Kunin, 1971). However, the spectrum of presenting symptoms and the incidence of renal tract abnormalities during the newborn period has not been known with certainty, due mainly to diagnostic difficulties. Mercy Maternity Hospital is a new obstetric hospital opened in March 1971, and in this hospital all infants are under the care of only two paediatricians. Though this system is not unique, it afforded the opportunity for the proper documentation of information to determine the incidence of renal tract abnormalities in newborn infants with urinary infection. Subjects and methodsFrom the opening of the Mercy Maternity hospital until December 1974, particular attention was given to the diagnosis of urinary infection in newborn infants. Suprapubic bladder puncture (Pryles et al., 1959) was performed in all infants presenting with jaundice of unknown aetiology, failure to gain weight, excessive weight loss, diarrhoea, vomiting, or a clinical picture of sepsis. A diagnosis of infection was accepted if there was any bacterial growth from the urine obtained by this method, and all such infants received a course of parenterally administered antibiotics. After 7 days of treatment they were subjected to intravenous pyelography and micturating cystourethrography. At the time of performing the cystourethrogram, urine was collected via the catheter and cultured; in only 2 infants was there still a significant growth of organisms. ResultsSelective suprapubic urine aspiration was performed in 905 infants; 64 were found to have urinary infection, representing 0 5% of all live-births over the 47 months of the study (total live-births 12 942). 54 (84%) were males and 10 (16%) were females. 14 (22%) were born before 37 weeks of gestation and 50 (78%) were term infants.

Several publications in the past few years have indicated that computed tomography (CT) pelvimetry is preferable to conventional pelvimetry when considering accuracy and radiation dose. Many of the previous publications have, however, compared state of the art CT pelvimetry with outmoded conventional pelvimetry techniques. This study compared both the accuracy and the radiation dose of CT pelvimetry with conventional pelvimetry as practised in two large teaching obstetric hospitals in Melbourne. The study did not demonstrate any significant difference in the accuracy between the two methods. The radiation dose to the fetal gonads was also similar. The radiation dose using CT pelvimetry could be significantly lowered if the axial CT section through the ischial spines were excluded from the CT technique.

The study suggests that isolated paraventricular cysts detected on routine cranial ultrasonography have no prognostic significance. However the study involved a small sample size with limited power of study (power = 0.3). A larger prospective cohort study would help to clarify the clinical significance of this condition.

In this 5-year review of 778 neonatal renal scans seen in an Obstetric Hospital, most infants were referred because of antenatal ultrasound findings, 92% with fetal pyelectasis. The results were classified according to the ultrasound findings. The majority of neonates (76%) had a normal postnatal scan. A number had vesicoureteric reflux (VUR) found on a micturating cystourethrogram. Persistant mild to moderate pyelectasis or hydronephrosis (15%) proved to be a normal variant in many infants, but had a similar appearance to those with an early obstructive cause (1%). Pyelectasis has proved to be a poor predictor of VUR. A protocol outlining paediatric management for neonates with persisting pyelectasis is included. There were 59 infants (8%) with a miscellaneous group of renal anomalies, many with a characteristic antenatal ultrasound appearance suggesting the diagnosis. These infants have been separately reported and illustrated (Part 2). Overall, 13% of infants were found to have significant findings of obstruction, VUR or miscellaneous anomalies affecting management.

In this 5-year review of 778 neonatal renal scans seen in an obstetric hospital, Mercy Hospital for Women, Melbourne, most infants were referred because of antenatal ultrasound findings. Ninety-two percent of these had fetal pyelectasis. The results were classified on the ultrasound findings. The majority of neonates (76%) had a normal postnatal scan. A number had vesicoureteric reflux found on micturating cystourethrogram. Persisting mild/moderate pyelectasis or hydronephrosis (15%) proved to be a normal variant in many infants, but had a similar appearance to those with an early obstructive cause (1%). There were 59 infants (8%) with a miscellaneous group of renal anomalies, many with a characteristic antenatal ultrasound appearance suggesting the diagnosis. Review of these 59 infants illustrates the anomalies seen and reports the associated investigations and subsequent outcome in most cases.