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Bladder/bowel dysfunction in pre-school children following febrile urinary tract infection in infancy
Sofia Sjöström1, Ulla Sillén2, Marc Bachelard1
1The Pediatric UroNephrology Center, The Queen Silvia Children's Hospital, The Sahlgrenska Academy at the University of Gothenburg, 416 85, Gothenburg, Sweden.
Insights
Children hospitalized with pyelonephritis in infancy have a high prevalence of bladder-bowel dysfunction (BBD) by preschool age. Early BBD assessment is recommended for children with urinary tract infections (UTIs), particularly those with a history of pyelonephritis.
Area of Science:
- Pediatric Nephrology
- Urology
- Pediatric Infectious Diseases
Background:
- Bladder-bowel dysfunction (BBD) is known to associate with urinary tract infections (UTIs).
- The long-term association between early-life UTIs and subsequent BBD post-toilet training remains less explored.
- This study investigates BBD prevalence in children with a history of pyelonephritis in infancy.
Purpose of the Study:
- To determine the prevalence of bladder-bowel dysfunction (BBD) in preschool-aged children with a history of pyelonephritis during their first year of life.
- To explore the association between BBD, recurrent UTIs, vesicoureteral reflux (VUR), and kidney damage in this cohort.
Main Methods:
- Ninety-two children hospitalized for pyelonephritis in infancy were assessed for BBD at a median age of 5.4 years.
- Validated BBD questionnaires, urine flow, and residual volume measurements were employed for diagnosis.
- Renal status, VUR, and recurrent UTI data were collected during follow-up.
Main Results:
- 38% (35/92) of children were diagnosed with BBD, primarily dysfunctional voiding (DV).
- BBD showed a strong association with recurrent UTIs (p < 0.0001) and kidney damage (p = 0.017).
- Children with both BBD and VUR had significantly higher rates of recurrent UTI (92%) compared to those with neither (23%).
Conclusions:
- A significant proportion (38%) of children with pyelonephritis in infancy develop BBD by preschool age, irrespective of VUR status.
- The findings highlight a critical link between early pyelonephritis, subsequent BBD, and recurrent UTIs.
- Routine BBD screening is advised for preschool children with UTIs, especially those with a history of infant pyelonephritis.
Background:
An association between bladder-bowel dysfunction (BBD) and urinary tract infection (UTI) is well-known. However, a question less explored is whether children with UTI early in life also have increased prevalence of BBD after they are toilet-trained. In this study, consecutively selected children with pyelonephritis during their first year of life were assessed for BBD at pre-school age.
Methods:
Ninety-two children (51 boys) hospitalized due to pyelonephritis during their first year of life were assessed for BBD at median age 5.4 years. A validated BBD questionnaire, along with urine flow and residual volume measurements, was used for diagnosing BBD. During follow-up, the group was well-characterized regarding renal status, vesicoureteral reflux (VUR), and recurrent UTI.
Results:
BBD was diagnosed in 35/92 (38%), of which the majority was sub-diagnosed with dysfunctional voiding (DV). There was a strong association between BBD and recurrent UTI during follow-up (p < 0.0001), but only a slight association with VUR status at presentation. Nevertheless, in the group with both BBD and VUR, recurrent UTI was four times higher (12/13, 92%) than in children who had neither VUR nor BBD (23%), (p = 0.0008). BBD was also associated with kidney damage (p = 0.017).
Conclusion:
In children with pyelonephritis during the first year of life, 38% had BBD at pre-school age, regardless of whether they had VUR or not. The study shows an important association between BBD and recurrent UTI, so an assessment of BBD is therefore recommended for pre-school children with UTI, especially when they have history of pyelonephritis during infancy.
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