Urinary tract infection in the newborn: clinical and radio imaging studies

Abstract

The objective of this study was to assess clinical characteristics and results of radio imaging studies and compare community-acquired urinary tract infection (UTI) with nosocomial UTI in 301 neonates with UTI consecutively admitted to 28 neonatal units in Spain over 3 years (community-acquired UTI, n = 250; nosocomial UTI, n = 51). UTI was diagnosed in the presence of symptoms of infection together with any colony growth for a single pathogen from urine obtained by suprapubic aspiration, or >or=10(4) CFU/ml for a single pathogen from urine obtained by urethral catheterization. Abnormal renal ultrasound was present in 37.1% of cases (34% in community-acquired UTI and 54.5% in nosocomial UTI, P < 0.01). The voiding cystourethrography (VCUG) showed vesicoureteral reflux (VUR) in 27% of cases (23.8% in community-acquired UTI and 48.6% in nosocomial UTI, P < 0.01). In patients with abnormal renal ultrasound and VUR, renal scan with dimercaptosuccinic acid (DMSA) performed early after UTI revealed cortical defects in 69.5% of cases. However, in patients with abnormal renal ultrasound and normal VCUG, DMSA also revealed cortical defects in 39% of cases. The absence of VUR in neonates with UTI and abnormal renal ultrasound does not exclude the presence of cortical defects suggestive of pyelonephritis.

Urinary Tract Infections in the Infant

“…5 However, even in the absence of any abnormalities on the RUS or VCUG, infants with UTI can have an abnormal DMSA scan, indicating renal cortical damage, although that may be an effect rather than a cause of a UTI. 29 Representative images for RUS and VCUG in infants are shown in Figs. 1 and 2.…”

Highlights for Management of a Child with a Urinary Tract Infection

“…In males, it is more common during neonatal period and early infancy and it declines afterwards [6]. Usually associated with anatomical abnormalities and outlet obstruction.…”

Escala predictiva diagnóstica de infección urinaria en neonatos febriles sin foco aparente

“…En nuestro trabajo confirmamos que la enfermedad afectaba más a los varones, con una relación hombre:mujer de 14,8:1. Otros autores informan que la ITU es más frecuente en varones con una relación hombre:mujer que va desde 2:1 hasta 6,6:1, dado el aumento de la incidencia de anomalías estructurales en los varones 19,20 . Observamos que 19,7% de neonatos presentaron anomalías estructurales tipo hidronefrosis y riñón poliquístico, mientras en el 3% se demostró pielonefritis.…”

“…La alteración estructural en ecografía para López Sastre J y cols., fue superior al nuestro con 34%, entre las cuales la hidronefrosis representó el 32,3%. Confirmamos igualmente que el 23,1% de las cistouretrografías miccionales realizadas identificaron reflujo vesicoureteral, cifra similar (23,8%) a la de López Sastre J y cols 19 .…”