Clinical Characteristics and Outcomes of the First Episode of Urinary Tract Infection in Neonates and Infants Younger than 2 Months of Age
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Purpose: The American Academy of Pediatrics provides guidelines for managing febrile urinary tract infection (UTI) in infants and children 2-24 months old, but little guidance is offered regarding UTIs in those younger than 8 weeks of age. The definition of UTI is unclear and whether to proceed with micturating cystourethrography (MCUG) or 99mtechnetium-dimercaptosuccinic acid (DMSA) scintigraphy scan in this age group is controversial. Methods: We retrospectively analyzed 29 neonates and infants younger than 2 months of age who underwent late DMSA scans 9 months following the first episode of febrile or symptomatic UTI between July 2009 and June 2016. Results: In total, 192 children aged 0-24 months underwent ultrasound and DMSA scans (MCUG in 174/192). Neonates and infants younger than 2 months of age were significantly less likely to develop fever, and had a lower fever peak, shorter duration of fever before admission and after starting antibiotics, longer hospitalization period, lower C-reactive protein, and greater incidence of non- Escherichia coli infection. There was no difference in pyuria response at diagnosis. The prevalence rates of an ultrasound abnormality (28%), vesicoureteral reflux (28%), UTI recurrence (38%), and renal scarring (10%) in infants younger than 8 weeks of age were similar to those in children 2-24 months old. Conclusion: Neonates and infants younger than 2 months of age with UTI warrant special consideration because the fever response used for diagnosis in older children may be absent or blunted. Clinical guideline is needed for the diagnosis and management of UTI in this age group.
Abstract
Purpose: The American Academy of Pediatrics provides guidelines for managing febrile urinary tract infection (UTI) in infants and children 2-24 months old, but little guidance is offered regarding UTIs in those younger than 8 weeks of age. The definition of UTI is unclear and whether to proceed with micturating cystourethrography (MCUG) or 99mtechnetium-dimercaptosuccinic acid (DMSA) scintigraphy scan in this age group is controversial. Methods: We retrospectively analyzed 29 neonates and infants younger than 2 months of age who underwent late DMSA scans 9 months following the first episode of febrile or symptomatic UTI between July 2009 and June 2016. Results: In total, 192 children aged 0-24 months underwent ultrasound and DMSA scans (MCUG in 174/192). Neonates and infants younger than 2 months of age were significantly less likely to develop fever, and had a lower fever peak, shorter duration of fever before admission and after starting antibiotics, longer hospitalization period, lower C-reactive protein, and greater incidence of non- Escherichia coli infection. There was no difference in pyuria response at diagnosis. The prevalence rates of an ultrasound abnormality (28%), vesicoureteral reflux (28%), UTI recurrence (38%), and renal scarring (10%) in infants younger than 8 weeks of age were similar to those in children 2-24 months old. Conclusion: Neonates and infants younger than 2 months of age with UTI warrant special consideration because the fever response used for diagnosis in older children may be absent or blunted. Clinical guideline is needed for the diagnosis and management of UTI in this age group.
참고문헌 (25)
- Lee YJ, "Risk factors for renal scar formation in infants with first episode of acute pyelonephritis: a prospective clinical study", J Urol, 187(3), pp.1032~1036 (2012)
- Yu Kyung An, "Which Factors Related to the Renal Cortical Defects in Infants Under 3 Months of Age with Urinary Tract Infections?", Childhood Kidney Diseases, 20(2), pp.57~62 (2016), 대한소아신장학회
- Bachur RG, "Predictive model for serious bacterial infections among infants younger than 3 months of age", Pediatrics, 108(2), pp.311~316 (2001)
- Tsai JD, "Diagnosis of pediatric urinary tract infections", Urol Sci, 27(3), pp.131~134 (2016)
- Subcommittee on Urinary Tract Infection, "Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months", Pediatrics, 128(3), pp.595~610 (2011)
- Subcommittee on Urinary Tract Infection, "Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2-24 Months of Age", Pediatrics, 138(6) (2016)
- Bonadio W, "Urinary tract infection in outpatient febrile infants younger than 30 days of age: a 10-year evaluation", Pediatr Infect Dis J, 33(4), pp.342~344 (2014)
- Hoberman A, "Pyuria and bacteriuria in urine specimens obtained by catheter from young children with fever", J Pediatr, 124(4), pp.513~519 (1994)
- Hoberman A, "Urinary tract infections in young febrile children", Pediatr Infect Dis J, 16(1), pp.11~17 (1997)
- International Reflux Study Committee, "Medical versus surgical treatment of primary vesicoureteral reflux: report of the International Reflux Study Committee", Pediatrics, 67, pp.392~400 (1981)
- Lebowitz RL, "International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children", Pediatr Radiol, 15(2), pp.105~109 (1985)
- Mandell GA, "Procedure guideline for renal cortical scintigraphy in children. Society of Nuclear Medicine", J Nucl Med, 38(10), pp.1644~1646 (1997)
- Jaye DL, "Clinical applications of C-reactive protein in pediatrics", Pediatr Infect Dis J, 16(8), pp.735~746 (1997)
- Turner MA, "Gestational age and the C reactive protein response", Arch Dis Child Fetal Neonatal Ed, 89(3), pp.F272~F273 (2004)
- Wener MH, "The influence of age, sex, and race on the upper reference limit of serum C-reactive protein concentration", J Rheumatol, 27(10), pp.2351~2359 (2000)
- Lin DS, "Urinary tract infection in febrile infants younger than eight weeks of age", Pediatrics, 105(2), pp.E20~ (2000)
- Ismaili K, "Febrile urinary tract infections in 0- to 3-month-old infants: a prospective follow-up study", J Pediatr, 158(1), pp.91~94 (2011)
- Bachur R, "Bacteremia and meningitis among infants with urinary tract infections", Pediatr Emerg Care, 11(5), pp.280~284 (1995)
- Crain EF, "Urinary tract infections in febrile infants younger than 8 weeks of age", Pediatrics, 86(3), pp.363~367 (1990)
- Shaikh N, "Association Between Uropathogen and Pyuria", Pediatrics, 138(1) (2016)
- Goldman M, "Imaging after urinary tract infection in male neonates", Pediatrics, 105(6), pp.1232~1235 (2000)
- Shaikh N, "Identification of children and adolescents at risk for renal scarring after a first urinary tract infection: a meta-analysis with individual patient data", JAMA Pediatr, 168(10), pp.893~900 (2014)
- Weems MF, "Urinary tract infections in a neonatal intensive care unit", Am J Perinatol, 32(7), pp.695~702 (2015)
- Matlow AG, "Nosocomial urinary tract infections in children in a pediatric intensive care unit: a follow-up after 10years", Pediatr Crit Care Med, 4(1), pp.74~77 (2003)
- Camacho-Gonzalez A, "Neonatal infectious diseases: evaluation of neonatal sepsis", Pediatr Clin North Am, 60(2), pp.367~389 (2013)