Prevalence and Clinical Significance of Urinary Tract Infection among Neonates Presenting with Unexplained Hyperbilirubinemia in Lebanon: A Retrospective Study

Abstract

Background

Neonatal jaundice is commonly seen in term and preterm newly born babies. It could be either physiologic or secondary to multiple underlying pathologies like urinary tract infection (UTI). Our main objective was to confirm the relationship between neonatal jaundice without apparent cause like hemolysis and the presence of UTI.

Materials and Methods

We, retrospectively over a period extended from 2017 to 2020, included 496 babies admitted for elevated indirect hyperbilirubinemia for whom demographic, clinical, laboratory, and therapeutic data were collected through a detailed questionnaire.

Results

Our study included 496 neonates and showed a prevalence of UTI in 8.9% of neonates. The two most common microorganisms in urine culture were Escherichia coli (65.9%) and Klebsiella pneumoniae (25.0%). A multivariate logistic analysis showed that UTI was associated with male neonates (odds ratio [OR] = 2.366, 95% confidence interval [CI]: 1.173 – 4.774; P = 0.016), history of prenatal UTI (OR = 5.378, 95% CI: 2.369 – 12.209; P <0.001), poor feeding (OR = 3.687, 95% CI: 1.570 – 8.661; P = 0.003), and positive urine culture in catheter (OR = 2.704, 95% CI: 1.255 – 5.826; P = 0.011). The mean length of stay was higher in patients with positive UTI (Median = 216 hours) compared to patients with negative UTI (Median = 48 hours) ( P <0.001).

Conclusion

Neonatal sreening for UTI should be recommended whenever there is unexplaind early or prolonged hyperbilirubinemia with no evidence of alloimmune hemolysis or blood group incompatibility and to prevent the morbidity of urosepsis and congenital kidneys malformations.

Graphical Abstract