Clinical Predictors for Abnormal Renal Bladder Ultrasound in Hospitalized Young Children With a First Febrile Urinary...

Area of Science:

• Pediatric Nephrology
• Diagnostic Imaging
• Infectious Diseases

Background:

• Routine renal bladder ultrasound (RBUS) is commonly performed in young children following a first febrile urinary tract infection (UTI).
• However, the diagnostic yield for serious anatomic anomalies is low, suggesting potential for a more targeted ultrasonography approach.
• This study investigates predictors of abnormal RBUS and its management impact in pediatric UTI.

Purpose of the Study:

• To identify clinical, prenatal ultrasound (PNUS), and illness characteristics that predict an abnormal RBUS in children with a first febrile UTI.
• To evaluate the impact of RBUS findings on the clinical management of these pediatric patients.

Main Methods:

• A single-center prospective cohort study included 211 hospitalized children aged 0-24 months with their first febrile UTI.
• Data collected included child demographics, PNUS results, and illness parameters.
• Abnormal RBUS was defined by a multidisciplinary consensus on the severity of ultrasound findings relevant to a first UTI.

Main Results:

• Of 211 children, 36% had an abnormal RBUS, with 47% classified as moderately severe and 53% as severe.
• No significant differences in clinical characteristics were observed between children with and without abnormal RBUS findings.
• Prenatal ultrasound was abnormal in 10% of cases; *Escherichia coli* was the most common pathogen (85%), and 20% had bacteremia.

Conclusions:

• No clinical predictors were identified to support a focused approach to RBUS in pediatric UTI.
• The study highlights the need for future research into the optimal timing for performing RBUS in children with febrile UTI.