Isolated Single Umbilical Artery as a Risk Factor for Urinary Tract Infections in Childhood
Nata Tifferet Willner1, Tamar Wainstock2, Asnat Walfisch3
1Faculty of Medicine, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Objective:
This study aimed to determine whether isolated single umbilical artery (iSUA), even absent identifiable genitourinary (GU) abnormalities, increases the risk of GU infection during childhood.
Study Design:
Retrospective population-based comparison of fetuses with iSUA versus normal three-vessel cords. Fetuses with growth restriction, prematurity, multiple gestations, and anatomical or chromosomal anomalies were excluded. The primary outcome was hospital-associated GU infection during the first 18 years of life. Kaplan-Meier's survival curves were used to assess cumulative risk; Cox's multivariable models were used to adjust for confounders.
Results:
Among 227,599 term singleton deliveries, children with iSUA (n = 729) had a higher incidence (1.8 vs. 0.6%, p < 0.001) and cumulative incidence (log-rank test, p < 0.001) of hospital-associated GU infection. The Cox's models confirmed these findings (hazard ratio: >2.82, confidence interval: 1.63-4.87 in composite models).
Conclusion:
iSUA represents an independent risk factor for GU infection. Urinary tract imaging may be warranted.
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