Is screening for urine infection in well infants with prolonged jaundice required? Local review and meta-analysis of existing data

Urinary tract infections (UTIs) are a common clinical problem in febrile infants younger than 8 weeks old, with a prevalence between 5% and 11%. Previous studies have noted that jaundice may be one of the first signs of a bacterial infection in infants. Our goal was to determine the incidence of UTIs in asymptomatic, jaundiced infants younger than 8 weeks old and to determine which historical and laboratory parameters are associated with UTIs. We prospectively evaluated asymptomatic, jaundiced infants younger than 8 weeks old for evidence of a UTI (defined as >10 000 colony-forming units per milliliter of a single pathogen, obtained by bladder catheterization). A serum fractionated bilirubin level was obtained on all study patients. Detailed questionnaires were completed, which included demographic information, prenatal, intrapartum, and postnatal events. Twelve (7.5%) of 160 infants had a UTI (95% confidence interval: 3.9%-12.7%). Isolated organisms included Escherichia coli, Enterobacter cloacae, Enterococcus, Klebsiella pneumoniae, group B Streptococcus, Streptococcus viridans, and Staphylococcus aureus. Patients with the onset of jaundice after 8 days of age had a higher incidence of UTI, 6 (50%) of 12 infants in the positive culture group, versus 15 (10%) of 148 infants in the negative culture group. Abnormal urinalysis and microscopy results were noted in 5 (42%) of 12 infants with a UTI, and 6 (55%) of 11 infants had abnormal renal ultrasound results. A UTI was found in 7.5% of asymptomatic, afebrile, jaundiced infants younger than 8 weeks old. In addition, infants with the onset of jaundice after 8 days of age or patients with an elevated conjugated bilirubin fraction were more likely to have a UTI. Therefore, we recommend that testing for a UTI be included as part of the evaluation in asymptomatic, jaundiced infants presenting to the emergency department. Show more

Bacteriuria was studied in an unselected population of 3,581 infants. Screening was performed at three time intervals during the infants' first year of life. The public Child Health Centers cooperated in the screening and bag samples were obtained from the infants with the parents help. Bacteriuria was verified by suprapubic aspiration. 94% of the infants took part in the screening and bacteriuria was confirmed in 14 girls (0.9%) and 36 boys (2.5%). An additional 20 girls (1.1%) and 20 boys (1.2%) in the study population presented with symptomatic urinary tract infection before 12 months of age. Bacteriuria in boys was predominantly found early in infancy both with screening techniques and through symptomatic urinary tract infections. Show more

Background: Jaundice is a common problem during the neonatal period. About 60% of the full term and 80% of premature infants develop jaundice. It can be associated with serious illnesses such as Urinary tract infections. Aims: The aim of this study is to evaluate the incidence and prevalence of urinary tract infection in newborns with indirect hyperbilirubinemia and to find a relationship with prolonged jaundice. Patients and Methods: We retrospectively evaluated asymptomatic, jaundiced neonates for evidence of a urinary tract infection. Data reviewed including demographic and historical data were included with data of blood studies, radiological evaluation and treatment. Results: 32 neonates of 152 cases had urinary tract infection. Most commonly isolated organisms were Klebsiella and Escherishia coli. Maximum duration of phototherapy was 4 days in the urinary tract infection group versus 7 in the non-urinary tract infection group. Intensive phototherapy was used in 18.7% in the urinary tract infection group versus 29.16% in the non-urinary tract infection group. None of the newborns in the urinary tract infection group underwent exchange transfusion therapy. Conclusion: Urinary tract infection can occur in asymptomatic, jaundiced newborns. Thus, it may be the first in these babies before other signs become evident. Show more