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Urinary tract infections in neonates with unexplained pathological indirect hyperbilirubinemia: Prevalence and
Elif Bahat Ozdogan1, Mehmet Mutlu2, Secil Arslansoyu Camlar1
1Department of Pediatrics, Division of Pediatric Nephrology, Karadeniz Technical University, Faculty of Medicine, Trabzon, Turkey.
Insights
Testing for urinary tract infections (UTIs) in newborns with unexplained jaundice is recommended. This study found a 12.2% UTI prevalence, highlighting the significance of screening and follow-up for these neonates.
Area of Science:
- Neonatal Medicine
- Pediatric Infectious Diseases
- Clinical Diagnostics
Background:
- The role of urinary tract infection (UTI) screening in neonates with unexplained indirect hyperbilirubinemia requiring phototherapy remains controversial.
- This study investigated the prevalence and clinical significance of UTIs in this specific neonatal population.
Purpose of the Study:
- To determine the prevalence of urinary tract infections (UTIs) in neonates presenting with unexplained indirect hyperbilirubinemia and requiring phototherapy.
- To assess the significance of UTIs in this group, including associated renal abnormalities and recurrence rates.
Main Methods:
- A cohort of 2- to 14-day-old neonates with indirect bilirubin levels above phototherapy thresholds and no other identified cause for hyperbilirubinemia were included.
- Urinary tract infection (UTI) diagnosis was confirmed by two consecutive urine cultures with significant bacterial growth (>10,000 colonies).
- Affected neonates underwent renal ultrasonography (US) and selected cases were followed for recurrent UTIs.
Main Results:
- The study included 262 neonates, with a UTI prevalence of 12.2% and a 6.2% rate of concurrent bacteremia among UTI-positive cases.
- Escherichia coli and Klebsiella pneumoniae were the predominant pathogens (81.2%).
- Renal abnormalities detected by US included pelvicaliectasis (12.5%) and increased renal parenchymal echogenicity (12.5%). Recurrent UTIs were observed in 23.5% of followed-up patients over a mean of 52 months.
Conclusions:
- Screening for urinary tract infections (UTIs) is warranted in neonates with unexplained pathological jaundice.
- All newborns diagnosed with a UTI should undergo renal ultrasonography (US) and be monitored for recurrent infections.
Background:
It is controversial to test for urinary tract infection (UTI) in patients with unexplained indirect hyperbilirubinemia in the first 2 weeks of life. We aimed to study the prevalence and significance of UTIs in such neonates who were requiring phototherapy.
Methods:
Subjects were 2- to 14-day-old neonates with indirect bilirubin levels above phototherapy limit with no other abnormality in their bilirubinaemia-related etiologic workup. UTI was diagnosed by 2 consecutive positive cultures obtained by catheterisation, documenting growth of >10,000 colonies of the same microorganism with consistent antibiograms. The UTI (+) patients were evaluated by renal ultrasonography (US), and some were followed up for possible recurrent UTI.
Results:
262 neonates were included in the study. UTI prevalence was 12.2%, and bacteraemia was 6.2% among UTI (+) patients. The two most common pathogens (81.2%) were Escherichiacoli and Klebsiella. pneumonia. All UTI (+) patients had undergone US, revealing 12.5% pelvicaliectasis, other 12.5% increased renal parenchymal echogenicity, 3.1% concurrent pelvicaliectasis and increased renal parenchymal echogenicity. 53.1% of UTI (+) patients had undergone follow-up, after which 23.5% recurrent UTI were found at the end of a mean of 52 months.
Conclusion:
We suggest that the neonates with unexplained pathological jaundice should be tested for possible UTI. Consequently, all newborns with UTI shall be evaluated by the urinary US and followed up for recurrent UTI.
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