Details
Category: Volume 07 Issue 10 October 2019
Hits: 1739

Title: Jaundice as sign of Urinary Tract Infection in Early Infancy: A hospital based Observational study

Authors: Neupane Shankar, Sharma Arun Kumar, Shrestha Laxman, Subedi Sonika

 DOI: https://dx.doi.org/10.18535/jmscr/v7i10.46

Abstract

  

Background: Neonatal jaundice is a common problem and often warrants extensive evaluation. Bacterial infections in neonates including urinary tract infection (UTI) can manifest with jaundice. Guidelines on management of afebrile, asymptomatic jaundiced infants do not necessarily include evaluation of UTI. The aim of this study was to determine the incidence of UTI in asymptomatic, jaundiced infants younger than 8 weeks old.

Methods: Significantly jaundiced infants aged 4 days to 8 weeks and born at ≥35 weeks of gestation who were otherwise well in outpatient and inpatient settings were prospectively included in the study. Infants were significantly jaundiced if they had jaundice visualized up to Kramer’s dermal zone 4 or 5 in first two weeks of life and/or jaundice prolonged beyond first two weeks of age. All significantly jaundiced infants underwent suprapubic aspiration for urine collection and UTI was diagnosed with isolation of any organism in the sample. A serum fractionated bilirubin level was obtained on all cases. All infants underwent other relevant investigations as indicated. A standardized questionnaire was completed to determine the relationship with demographic features and prenatal, intranatal, and postnatal events.

Results: One hundred and twenty-six infants, 81 (64.3%) of whom were boys were enrolled at a mean age of 16±14 days. Most of the neonates (118, 93.7%) had onset of jaundice within 4-14 days of life. Only one out of 126 infants (0.8%) had a diagnosis of UTI, Escherichia coli was isolated as a causative organism. Etiology of jaundice was established as breast milk jaundice in majority of infants (122, 96.8%). Since there was a single patient with UTI, the influence of various risk factors upon incidence of UTI could not be analyzed.

Conclusion: A very low incidence of UTI was identified in infants with jaundice. The study failed to show significant association between jaundice and UTI. Routine evaluation for UTI may not be suggested in asymptomatic jaundiced neonates. Further studies in larger population should be performed to determine if newborns with asymptomatic jaundice require routine evaluation for UTI.

Keywords: Jaundice, Urinary Tract Infection, Infant, Kramer’s dermal zone.

References

  1. Chou RH, Palmer RH, Ezhuthachan S et al. (2003). Management of hyperbilirubinemia in newborns: measuring performance by using a benchmarking model. Pediatrics, 112: 1264–73.
  2. Garcia FJ, Nager AL. Jaundice as an early diagnostic sign of urinary tract infection in infancy. 2002 May; 109(5):846-51.
  3. Elder JS. Urologic disorder in infants and children In Behrman, Kleigman, eds. Nelson Text Book of Pediatrics. Philadelphia; WB. Saunders, 2004; 1812-1814.
  4. Maisels MJ. Mixed forms of jaundice In Mac Donald, ed. Avery’s Neonatology Pathophysiology & Management of the Newborn. Lippincott; Williams & Wilkins, 2005; 807-808.
  5. Bilgen H OE, Unver T, Biyikli N, Alpay H, Cebeci D. Urinary tract infection and hyperbilirubinemia. Turk J Pediatr. 2006;48:51-5.
  6. Ginsburg CM MG. Urinary tract infections in young infants. Pediatrics. 1982;69:409-12.
  7. Bourchier D AG, Maling TMJ. Radiological abnormalities in infants with urinary tract infections. Arch Dis Child. 1984;59:620-4.
  8. Ring E ZG. Urinary infection and malformations of urinary tract in infancy. Arch Dis Child. 1988;63:818-20.
  9. Tsingoglou S DJ. Lower urinary obstruction in infancy. Arch Dis Child. 1972;47:215-7.
  10. Rushton HG MM. Dimercaptosuccinic acid renal scintigraphy for the evaluation of pylonephritis and scarring: a review of experimental and clinical studies. J Urol. 1992;148:1726-32.
  11. Greenfeld SP WJ. Vesicoureteral reflux: practical aspects of evaluation and management. Pediatr Nephrol. 1996;10:189-794.
  12. Struthers S SJ, Parker K, Goddard J, Hallett R. Parental reporting of smelly urine and urinary tract infection. Arch Dis Child. 2003;88:250-2.
  13. Robertson WO, lmquist JR, Light IJ, Maisels MJ et al. American Academy of Pediatrics, Provisional Committee for Quality Improvement, Practice parameter: management of hyperbilirubinemia in the healthy term newborn. Pediatrics 199; 94(4): 558-65.
  14. Shahian M, Rashtian P, Kalani M .Unexplained neonatal jaundice as an early diagnostic sign of urinary tract infection. Int J Infect Dis 2012; 16 (7):487-90.
  15. JM L. Sixty-six infants with urinary tract infection in first month of life. Arch Dis Child. 1972;47:218-26.
  16. Krober MS BJ, Powell JM, Smith FR, Seto DS. Bacterial and viralpathogens causing fever in infants less than 3 months old. Am J DisChild. 1985;139:889-92.
  17. Crain EF GJ. Urinary tract infections in febrile infants younger than 8 weeks of age. Pediatrics. 1990;86:363-7.
  18. Hoberman A CH, Keller DM, Hickey R, Davis H, Ellis D. Prevalence of urinary tract infection in febrile infants. J Pediatr. 1993;123:17-23.
  19. Hoberman A WE. Urinary tract infections in young febrile children. Pediatr Infect Dis J. 1997;16:11-7.
  20. Lawrence M. Gartner IMA. Studies of prolonged neonatal jaundice in the breast-fed infant. The Journal of Pediatrics 1966;68(1):54-6.
  21. Mutlu M, Cayır Y, Aslan Y. Urinary tract infections in neonates with jaundice in their first two weeks of life.  World J Pediatr. 2014 May; 10(2):164-7.
  22. Nader Pashapour AAN, Sariyeh Golmohammadlou. Urinary Tract Infection in Term Neonates with Prolonged Jaundice. Pediatric Urology Journal 2007;4(2).
  23. Kring MJMaE. Risk of Sepsis in Newborns With Severe Hyperbilirubinemia. Pediatrics. 1992;90:741.
  24. Hannam S, McDonnell M, Rennie JM. Investigation of prolonged neonatal jaundice. Acta Paediatr 2000;89(6):694-7.
  25. Tosif S BA, Oakley E, Donath S, Babl FE. Contamination rates of different urine collection methods for the diagnosis of urinary tract infections in young children: an observational cohort study. J Paediatr Child Health. 2012;48(8):659.
  26. McCandless DW. History of Bilirubin Pediatrics. 2011 (XIV):286.
  27. Joseph J. Zorc DALea. Clinical and Demographic Factors Associated With Urinary Tract Infection in Young Febrile Infants. Pediatrics. 2005;116:644.
  28. Schalger TA (2001). Urinary Tract Infections in Children Younger Than 5 Years of Age. Paediatric Drugs 3(3): 219-227.
  29. Kivlahan C JE. The natural history of neonatal jaundice. Pediatrics. 1984;74:364-70.
  30. Crofts DJ, Michel VJ-M et al. Assessment of stool colour in community management of prolonged jaundice in infancy. Acta Pediatr 1999;88:969-74.
  31. Long SS KJ. Infectious Diseases of the Fetus and Newborn Infant 5th edition ed: WB Saunders; 2001.
  32. Lee HC FS, Yeung CY, Tsai JD. Urinary tract infections in infants: comparison between those with conjugated vs unconjugated hyperbilirubinaemia. Ann Trop Paediatr. 2005;25:277-82.
  33. Thurman WG. "Changes in red cell fragility with infection." American Journal of Diseases of Children. 1960;100(4).
  34. SEELER RA. Urosepsis With Jaundice Due to Hemolytic Escherichia coli Am J Dis Child. 1973;126(3):414.
  35. Briton L SL, Edelman CM. Neonatal-prenatal medicine. London: Mosby; 2002.
  36. Edelman CM OJ, Fine BP, Martinez AB. The prevalence of bacteriuria in full-term and premature newborn infants. J Pediatr. 1973;82:125-32.
  37. Drew JH AC. Radiological findings in newborn infants with urinary infection. Arch Dis Child. 1976;51:628-30.
  38. Wettergren B JU, Jonasson G. Epidemiology of bacteriuria during the first year of life. Acta Paediatr Scand. 1985;74:925-33.
  39. Ghaemi S FR, Kelishadi R. Late onset jaundice and urinary tract infection in neonates. Indian J Pediatr. 2007;74(2): 139-41.
  40. Landau D TM, Brennan J, Majd M. The value of urinalysis in differentiating acute pyelonephritis from lower urinary tract infection in febrile infants. Pediatr Infect Dis J. 1994;13:777-81.
  41. Goldman M LE, Strauss S, et al. Imaging after urinary tract infection in male neonates. Pediatrics. 2000;105:1232-5.

Corresponding Author

Neupane Shankar

Shankarapur Hospital, Kathmandu, Nepal