Incidence and risk factors of urinary tract infection in very low birth weight infants.

OBJECTIVES: To describe the incidence and associated risk factors of urinary tract infection (UTI) in very low birth weight (VLBW) infants and to determine the value of diagnostic imaging studies after the first UTI episode before discharge from the neonatal intensive care unit (NICU). METHODS: VLBW infants born during 2003-2012 were reviewed for UTI. In a nested case-control study, potential risk factors of UTI were compared between infants with UTI (cases) versus birth weight and gestational age matched controls. Renal ultrasonography (USG) and voiding cystourethrography (VCUG) results were reviewed in cases. RESULTS: During the study period, 54.7% of urine culture specimens were collected by sterile methods. 3% (45/1,495) of VLBW infants met the study definition for UTI. UTI was diagnosed at mean postnatal age of 33.1±22.9 days. There was no significant difference in gender, ethnicity, antenatal steroid exposure, blood culture positive sepsis, ionotropic support, respiratory support and enteral feeding practices between cases and controls. Cases had a significantly higher cholestasis compared to controls (22% vs. 9% ; p = 0.03). However, cholestasis was not a significant predictor of UTI in the adjusted analysis [adjusted OR 2.38 (95% CI 0.84 to 6.80), p = 0.11]. Cases had higher central line days, parenteral nutrition days, total mechanical ventilation days, chronic lung disease, and length of stay compared to controls. Renal USG was abnormal in 37% and VCUG was abnormal in 17% of cases. CONCLUSIONS: The incidence of UTI in contemporary VLBW infants is relatively low compared to previous decades. Since no significant UTI predictors could be identified, urine culture by sterile methods is the only reliable way to exclude UTI. The majority of infants with UTI have normal renal anatomy. UTI in VLBW infants is associated with increased morbidity and length of stay.

Renal radionuclide imaging, an evergreen forty years old.

Urinary tract congenital abnormalities (UCA) and febrile infections (UTI) are, respectively, 2 of the commonest congenital and acquired health problems in childhood. In both, radionuclide imaging still represent a cornerstone of diagnostic imaging, although the involved techniques are more or less the same from the early '80 s. During the last 2 decades, published papers focused on a deep revision about the optimal use and usefulness of such imaging tools in affected children, with the aim of reducing invasiveness, radiation burden and costs without losing efficacy. This approach leads to different results. In UCA, no consensus for a diagnostic algorithm was up to now reached, whilst, about febrile UTIs, guidelines were published in 2007 by the UK's National Institute for Clinical Excellence (NICE) and by the European Society of Paediatric Radiology (ESPR), in 2011 by the American Academy of Paediatrics (AAP), and in 2012 by the Italian Society of Paediatric Nephrology (SINP). Nevertheless, new data continuously arise and the scientific debate always revives. Every imaging tool now available has its own strengths and weaknesses, and so all published guidelines. All this body of knowledge must be critically analysed for obtaining a complete, up-to-date and flexible overview about these "always hot" topics.

Urinary tract infection in the newborn and the infant: state of the art.

Urinary tract infection is one of the most common causes of infection in newborns. Obtaining a urinary tract infections (UTIs) diagnosis just on the basis of the clinical findings is frequently difficult, however, being the pediatrician's goal to reduce the risk of renal scarring, a prompt diagnosis and treatment is of extreme importance. The key instrument for the diagnosis of UTIs is represented today by urine culture. However, in reality, the caregivers and investigators are increasingly demanding fast and cheap methods for a rapid and effective diagnosis.

Ultrasonography and neonatal urinary tract infections.

B-mode ultrasonography and the power-Doppler are methods for studies by images in rapid technological evolution. Their applications and limits in the study of infections of the urinary tract in the neonatal period are pointed out.

The practice of urethral dilation for voiding dysfunction among fellows of the Section on Urology of the American Academy of Pediatrics.

PURPOSE: Review of the literature reveals little scientific evidence to prove or disprove the efficacy of urethral dilation for children with dysfunctional voiding and recurrent urinary tract infections. We ascertain the current practice of urethral dilation among pediatric urologists. MATERIALS AND METHODS: An anonymous questionnaire regarding the practice of urethral dilation was mailed to all fellows in the Section on Urology of the American Academy of Pediatrics. The questionnaire contained 14 questions and included biographical information. RESULTS: The questionnaire response rate was 64%. When asked how one would treat a typical female child with classic voiding dysfunction, 87% responded with timed voiding and relaxation techniques with or without anticholinergics. Only 2.5% would proceed directly to cytoscopy and urethral dilation. For patients who did not respond to initial treatment, 67% would proceed with either urodynamics or biofeedback and only 10% would then perform urethral dilation. Of responders 61% do not practice urethral dilation under any circumstance, 36% will use it when all other means of therapy have failed, while only 2% use urethral dilation regularly and 2% find it helpful and will occasionally use it. Among physicians who perform urethral dilation 63% believed that less than half of the patients experienced long-term improvement. Overall, there was no consensus as to mechanism of action of urethral dilation. CONCLUSIONS: Urethral dilation is rarely used as primary treatment for pediatric voiding dysfunction, is usually reserved until all other treatments have failed and appears to have long-term efficacy in less than 50% of patients. To define better the need for this treatment modality and its efficacy, a randomized prospective trial is mandatory.

Infección urinaria en el lactante / Infant urinary tract infection

Se realizó un estudio descriptivo y longitudinal sobre la infección aguda del tracto urinario en el niño de un año durante el período comprendido desde el primero de enero hasta el 31 de diciembre de 1999 con el objetivo de evaluar el comportamiento de la urosepsis en el lactante y su relación con el sexo, formas clínicas de presentación y malformaciones congénita asociadas. El universo de trabajo estuvo representado por 150 niños ingresados en el hospital durante el año con el diagnóstico presuntivo de urosepsis, de los cuales en 62 niños se comprobó micro biológicamente la existencia de infección urinaria con los que se formó la muestra para este trabajo. Se confeccionó una encuesta con las variables a estudiar. Como método de tabulación se utilizó el conteo simple y como método estadístico la prueba de Chi cuadrado de independencia u homogeneidad, los resultados se expresaron en números absolutos y por ciento. En el trabajo se pudo apreciar como resultado relevante una mayor incidencia de infección en el lactante menor de cuatro meses con predominio en el sexo masculino, posteriormente se incrementó en las niñas; la forma febril aguda fue la más frecuente. Se le concluyó que a todo niño con este diagnóstico se le completan los estudios por la posibilidad de tener asociado una malformación congénita del tracto urinario(AU)

[Pre- and postpartum ultrasound examinations for diagnosis of urogenital abnormalities]. / Prä- und postpartale Ultraschalluntersuchungen zur Diagnostik von Urogenitalfehlbildungen.

BACKGROUND: The aim of the study was to evaluate prenatal and postpartal sonographic investigations to diagnose congenital uropathies. PATIENTS/METHODS: The Mainz birth defect monitoring system, the "Mainzer Model", was launched in 1990. Over a period of five years (1/90 to 1/95) 19,028 newborns underwent postpartal sonographic examination. Anamnestic data including prepartal sonographic examination were collected. According to a defined ultrasound criteria list, ultrasound findings were considered normal in 94.8% of the neonates, 4.4% were defined as requiring a follow-up examination and 0.8% were pathological. In the current study we analyzed patients with pathological findings with their pre- and postpartal sonographic investigations as well as their clinical data (urinary tract infections, operative procedures). RESULTS: In the study group prenatal ultrasonography showed evidence of severe anomalies only in 51 fetuses (32.9%). Surgical correction was required in 39 cases. 20 (51%) have been diagnosed prenatally. 28 patients presented with urinary tract infections. Out of this group only 11 patients have been detected by prenatal ultrasound. CONCLUSION: In conclusion, postnatal ultrasound is more effective to diagnose anomalies of the urinary tract. To prevent complications i.e. urinary tract infections a neonatal screening program would be valuable.

[Evaluation of bacteriological research data and laboratory symptoms of infection in the diagnosis of congenital and acquired infections]. / Ocena wyników badán bakteriologicznych oraz laboratoryjnych wykladników infekcji w rozpoznawaniu zakazen wrodzonych oraz nabytych.

The predisposition of the newborns to contract infections diseases is dependent upon the limited efficiency of their immune mechanisms. Congenital infections amount to 5.7% in the research material, and the acquired infections 1.15%. The isolation of the microorganism is the basis for treating infections-the profiles of the pathogenic bacterial in flora were subjected to analysis. Im generalised infections Stafphylococcus epidermidis makes 56.6% and E. Coli accounts for 87.5 of the infections of the urinary system. In our research the late sepsis and pneumonia are more frequently the result of the hospital infection (14.2%) in the cases of congenital infections-pneumonia and the infection of the urinary system (72%). Hematologic indicators such as: leucopenia, thormbocytopenia, I/T are distinct infection markers (those were found in 31% of the cases). The CRP protein shows the lowest values in congenital infections, still monitoring its level is useful for assessing the effectiveness of the undertaken antybacterial treatment. The newborns of male sex (58%) more often prone to infection. Pneumonia is the manifestation pertaining to an organ in 70% of congenital infections, the infection of urinary system amounts to 17.1%.

Ectopic ureter with complete ureteric duplication: conservative surgical management.

To assess the outcome of conservative procedures, the authors reviewed their experience in the management of 31 ectopic ureters with complete ureteric duplication. Twenty-eight girls and three boys (aged 19 days to 10 years; mean, 30 months) were operated on between 1968 and 1994. Twenty-four of the children presented for evaluation of dribbling urinary incontinence and/or febrile urinary tract infections; seven presented after prenatal ultrasonographic diagnosis of hydronephrosis. The location of the ectopic orifice was identified in 25 children: bladder neck (6), posterior urethra (6), vagina (7), and vestibule (6). Upper pole nephroureterectomy was performed in 16 children who had nonfunctioning renal segments. Ureterovesical reimplantation was performed in 10 children who had functioning segments. In five borderline cases, temporary cutaneous ureterostomy was performed, followed by ureteropyelostomy (2), ureterovesical reimplantation (2), and upper pole nephrectomy (1). Histological examination of the polar nephrectomy specimens showed lesions of dysplasia in only four cases (24%). The follow-up period ranged from 6 months to 20 years (mean, 66 months). All children who presented with incontinence became continent after polar nephrectomy or conservative surgery. One child required surgical revision of the ureteropyelostomy anastomosis. Of the 12 children who had ureterovesical reimplantation, none needed further procedures. Ectopic ureters in duplex systems with functioning renal segments should be conserved.

Urodinamia en niños con infección urinaria recurrente, enuresis e incontinencia / Urodynamic studies in enuresis, vesical incontinence and urinary tract infections

Se presentan los resultados clínico-urodinámicos de 50 pacientes pediátricos, 46 de ellos mujeres, neurológicamente normales que consultaron por enuresis, incontinencia o infección urinaria recurrente, aisladas o en asociación. La mayoría de los pacientes (n = 33) presentaba asociación de los tres síntomas y 3 tenían evidencia de reflujo vesicouretral. Cistométricamente la vejiga hiperactiva fue la más frecuente y la hipoactiva la de menor frecuencia. Las presiones de micción son significativamente mayores en las vejigas hipertónicas y menores en las hipotónicas. Sólo las vejigas hipotónicas muestran capacidad significativamente mayor y flujo máximo menor que los valores normales

Neonatal hydronephrosis: 146 cases.

Recognition and precise etiologic diagnosis of neonatal hydronephrosis is worthwhile since, although often severe, it is usually treatable with at least partial success. This relatively favorable prognosis, despite dilatation that may be marked, suggests a greater regenerative capacity at this age, or may be due to the relative infrequency or short duration of the infection.