Should you test for urinary tract infection in children with respiratory symptoms?

QUESTION: An 8-month-old boy presented to our clinic with a 3-day history of fever. He has had a cough and rhinorrhea since the onset of the fever, and his 4-year-old sibling has recently had cough and cold symptoms. I have heard that the presence of respiratory symptoms means that urinary tract infection (UTI) is less likely. In infants with fever and respiratory symptoms, who should have a sample collected for urinalysis for UTI? ANSWER: The approach to diagnosing febrile infants who have respiratory symptoms varies by age. Urinalysis should be done for all febrile infants younger than 2 months of age, regardless of whether they have respiratory symptoms. Clinicians should assess risk factors for UTI in every infant between 2 and 24 months of age and should not exclude the diagnosis of UTI based on respiratory symptoms alone. Use of a predictive tool to estimate the pretest probability of UTI would aid decision making about patients in this population.

Faut-il dépister une infection des voies urinaires si un enfant a des symptômes respiratoires?

QUESTION: Un garçon de 8 mois est amené à notre clinique parce qu'il fait de la fièvre depuis 3 jours. Depuis l'apparition de la fièvre, il présente de la toux et une rhinorrhée, et son petit frère de 4 ans a aussi eu récemment de la toux et des symptômes du rhume. J'ai entendu dire que la présence de symptômes respiratoires signifiait une moins grande probabilité d'infection des voies urinaires (IVU). Chez quels nourrissons fébriles qui ont des symptômes respiratoires devrait-on faire un prélèvement pour procéder à une analyse d'urine en vue de dépister une IVU? RÉPONSE: La façon de poser un diagnostic chez des nourrissons fébriles présentant des symptômes respiratoires varie selon l'âge. Une analyse d'urine devrait être effectuée chez tous les nourrissons fébriles de moins de 2 mois, qu'ils aient ou non des symptômes respiratoires. Les cliniciens devraient évaluer les facteurs de risque d'une IVU chez tous les nourrissons âgés de 2 à 24 mois et ne devraient pas exclure un diagnostic d'IVU en se fondant seulement sur la présence de symptômes respiratoires. Le recours à un outil prédictif pour estimer la probabilité d'une IVU avant le test pourrait aider à la décision chez les patients de cette population.

Treatment Delay of Febrile Urinary Tract Infections Among Infants With Respiratory Symptoms.

OBJECTIVE: To evaluate whether antibiotic treatment of febrile urinary tract infection (UTI) is delayed in febrile infants with respiratory symptoms compared with those without. STUDY DESIGN: Data of infants 2-24 months of age diagnosed with UTI from March 1, 2012 to May 31, 2023 were collected from our hospital's medical charts and triage records. Patients with known congenital anomalies of the kidney and urinary tract or a history of febrile UTI were excluded. Patients were classified as having respiratory symptoms if they had any of the following symptoms or clinical signs: cough, rhinorrhea, pharyngeal hyperemia and otitis media. Time to first antibiotic treatment from fever onset was compared between patients with and without respiratory symptoms. A Cox regression model was constructed to adjust for potential confounders. RESULTS: A total of 214 patients were eligible for analysis. The median age of the eligible patients was 5.0 months (interquartile range: 3.0-8.8) and 118 (55%) were male. There were 104 and 110 patients in the respiratory symptom and no respiratory symptom groups, respectively. The time to first antibiotic treatment was significantly longer in the group with respiratory symptoms (51 hours vs. 21 hours). Respiratory symptoms were significantly associated with a longer time to first treatment after adjustment for age and sex in the Cox regression model (hazard ratio = 0.63, 95% confidence interval: 0.47-0.84). CONCLUSIONS: Treatment of febrile UTI infants with respiratory symptoms tends to be delayed. Pediatricians should not exclude febrile UTI even in the presence of respiratory symptoms.

Identifying Kawasaki Disease With a Low Coronary Artery Aneurysm Risk.

INTRODUCTION: Kawasaki disease (KD) patients with a high risk of coronary artery aneurysm (CAA) development are well characterized and targeted for intensified primary intravenous immunoglobulin (IVIG) treatment. However, the characteristics of KD patients with a low CAA risk are less well-known. METHODS: The present study was a secondary analysis of Prospective Observational study on STRAtified treatment with Immunoglobulin plus Steroid Efficacy for Kawasaki disease (Post RAISE), a multicenter, prospective cohort study of KD patients in Japan. The target of the analysis was patients with a Kobayashi score <5 who were predicted to respond to IVIG. The incidence of CAA during the acute phase, the primary outcome, was assessed based on all echocardiographic evaluations performed between week 1 (days 5-9) and month 1 (days 20-50) after the start of primary treatment. Multivariable logistic regression was used to identify the independent risk factors of CAA during the acute phase, based on which a decision tree was created to identify a subpopulation of patients with KD with a low CAA risk. RESULTS: Multivariate analysis found that a baseline maximum Z score >2.5, age <12 months at fever onset, nonresponsiveness to IVIG, low neutrophils, high platelets and high C-reactive protein were independent predictors of CAA during the acute phase. The decision tree created by using these risk factors identified 679 KD patients who had a low incidence of CAA during the acute phase (4.1%) and no medium or large CAA. CONCLUSIONS: The present study identified a KD subpopulation with a low CAA risk comprising around a quarter of the entire Post RAISE cohort.

Tracheobronchial rupture in children due to chest compression.

A tracheobronchial rupture can be lethal. Its etiology in children varies and includes blunt trauma and iatrogenic injury. Most of the latter are associated with tracheal intubation, with other, iatrogenic causes scarcely being reported. We herein reported the first case of tracheobronchial rupture caused by chest compression during cardiopulmonary resuscitation. The present case highlights the importance of close follow-up after cardiopulmonary resuscitation, even if the patients are not intubated.

Abdominal Pain in a 15-Year-Old Adolescent Girl.

A 15-year-old adolescent girl taking an oral contraceptive had 3 days of pain in a 1-cm area of the lower left abdominal quadrant. She had no nausea/vomiting, diarrhea, hematochezia, bloating, or anorexia; no precipitating factors for the pain; and no history of pregnancy, abdominal surgery, or abdominal trauma. Results from laboratory tests, endoscopy, and abdominal computed tomography were normal. What is the diagnosis and what would you do next?