Urinary tract infection and hyperbilirubinemia

Area of Science:

• Neonatal Medicine
• Pediatric Urology
• Infectious Diseases

Background:

• Unexplained indirect hyperbilirubinemia in newborns is common.
• Urinary tract infection (UTI) is a known cause of prolonged jaundice.
• The incidence of UTI in asymptomatic jaundiced newborns is not well-established.

Purpose of the Study:

• To determine the incidence of UTI in newborns presenting with asymptomatic, unexplained indirect hyperbilirubinemia.
• To evaluate the clinical and diagnostic findings associated with UTI in this population.

Main Methods:

• A prospective study of 102 newborns with indirect hyperbilirubinemia (total bilirubin > 15 mg/dl) in the first two weeks of life.
• Bilirubin work-up, urinalysis, and urine culture via bladder catheterization were performed.
• Patients diagnosed with UTI were further evaluated with sepsis screening, renal function tests, renal ultrasound, voiding cystourethrogram (VCUG), and dimercaptosuccinic acid scintigraphy (DMSA).

Main Results:

• UTI was diagnosed in 8% of the infants.
• Common pathogens included Enterobacter aerogenes, Enterococcus faecalis, Klebsiella pneumoniae, and Escherichia coli.
• Bacteriuria was present in 88% of UTI cases, while pyuria was found in 50%.
• Renal abnormalities were detected in 38% of infants with UTI via ultrasound, and one infant had reflux on VCUG.

Conclusions:

• UTI should be considered in the differential diagnosis of asymptomatic, jaundiced newborns, particularly those older than three days.
• Urine culture is an essential component of the work-up for unexplained hyperbilirubinemia in infants.
• Early diagnosis and management of UTI in jaundiced newborns can prevent potential renal complications.