Urinary disorders occurring in the neonatal period

Abstract

Urinary conditions with a distinctive clinical picture are not uncommon in newborn infants. The majority of infants show excellent response to treatment and early diagnosis is of great importance. In any circumstances it is difficult to obtain specimens of urine from these small subjects and the difficulties are frequently increased as a result of the anuria which is a common accompaniment of urinary disorders in its early stages. Usually the characteristic clinical features of these cases allow of a diagnosis being made and treatment being begun before examination of the urine has been possible.It is the purpose of this paper to give an account of observations made on a series of sixty-one cases collected over a period of three years. Details are given of urinary findings in these cases as well as in a series of healthy newborn infants, clinical signs and symptoms are described, treatment is indicated and the results recorded. Autopsy findings are given in connection with certain of the fatal cases and details of progress after discharge from hospital in children who recovered.Material. Specimens of urine were obtained from newborn infants in the Royal Maternity Hospital and the Western General Hospital, Edinburgh. A large number were from healthy children and provided a control series. Of the sixty-one children with urinary infection fifty-two were born in the former and nine in the latter hospital: all were under observation from the time of birth. Twelve children included in this series attended the Infant Clinic in connection with the Royal Maternity Hospital and were examined at intervals for a period varying from seven months to two years. Of those not regularly attending the clinic twelve reported by request, fifteen were visited in their homes and replies to a questionnaire were received in connection with nine others. Four children could not be traced: nine died while still in hospital.Method of examination of the urine.-Specimens of urine from female cases were obtained by catheter: in male infants they were collected -in test-tubes attached to the penis unless required for bacteriological investigation when catheter specimens were employed. Microscopical examination of the urine was carried out as soon as possible after receipt of the specimen, which was thoroughly stirred but not centrifugalized. The high-power lens was employed throughout and the findings recorded in not -fewer than fifteen fields in connection with each specimen. This method of examination was along lines suggested by Thomson"5,

66 Infants with Urinary Tract Infection in First Month of Life

“…In the majority the clinical illness was severe and the condition regarded as a rarity by the authors (Smith, 1918;Helmholz, 1918;Graham, 1925;Sauer, 1925;Conrad 1926;Paterson, 1931;Florman and Bass, 1943). The series of Craig (1935) was exceptional in that 61 infants were reported; the majority had severe clinical disturbance.…”

“…The overall mortality was 11 % and further infection occurred in 37% of girls and in 10% of the boys. A clinical classification for the condition is suggested.Though urinary tract infection is a relatively common occurrence in the first month of life (Craig, 1935;James, 1959;Lincoln and Winberg, 1964;O'Doherty, 1968;Littlewood, Kite, and Kite, 1969), there are few large series of such infants reported. Previous publications reveal a lack of general agreement as to the usual clinical picture to be expected, which is probably due to the fact that some authors are reporting infants clinically ill with urinary infection, together with other infants who have been detected when the condition is causing little clinical disturbance.…”

"Clean catch" urines in the newborn--bacteriology and cell excretion patterns in first week of life.

“…The high number of renal tubular cells excreted in the first few days of life has been noted by earlier workers (Craig, 1935;-Thomson, 1944 ;Lawson and Hewstone, 1964). The similarity in size and shape of unstained renal tubular cells and leucocytes has in the past made differentiation difficult, but with the peroxidase-positive stain the particular pattern of renal tubular cell excretion emerges.…”

Prevalence of urinary tract infection in children of preschool age

“…A higher frequency of infection in male neonates than in females has often been recorded (e.g. Craig, 1935;Neumann and Pryles, 1962;Stansfeld, 1966;Bergstrom, 1972;Littlewood, 1972) and has been attributed to a greater prevalence of congenital abnormalities of the urinary tract in males (Hutchison, 1965) and to the mode of infection thought usually to be blood-borne (Littlewood, 1972). In contrast, the prevalence of bacteriuria in schoolchildren shows a marked excess among girls, and Kunin (1968) has reported that the prevalence rises steadily with age with an annual acquisition rate of 0 32o%.…”