Are the Clinical outcomes of Neonates and Infants Under 2 Months Old with Urinary Tract Infections Similar to those in Infants 2 to 12 Months Old?
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Purpose: Although the American Academy of Pediatrics provides clinical guidelines for urinary tract infection (UTI) infants, guidelines are not appropriate for neonates and infants less than 2 months of age due to insufficient data. The aim of this study was to evaluate the characteristics of neonates and young infants less than 2 months old (group 1) with UTI compared to older infants from 2 to 12 months old (group 2). Methods: We reviewed UTI patients aged 0 to 12 months admitted to the pediatric department in the last 5 years. Clinical characteristics such as age, sex, fever duration, recurrence, progression to acute pyelonephritis (APN), malformations like hydronephrosis and vesicoureteral reflux (VUR), and laboratory results were compared between group 1 and group 2. Results: 615 patients were included in this study. Group 1 had 94 cases and group 2 had 521 cases. Escherichia coli was the most commonly isolated pathogen in urine cultures. Fever duration was shorter in group 1 (vs.) 2 (1.91±1.43 days vs. 3.42±2.40 days, P<0.05). As compared to group 2, group 1 had a higher proportion of patients with antenatal hydronephrosis and hydronephrosis found after admission (10.6% vs. 3.6% and 75.5% vs. 55.9%, P<0.05). There were differences between two groups in white blood cell (WBC) count (Group 1: 13,694±5,315/μL, Group 2: 15,271±6,130/μL, P<0.05) and C-reactive protein (Group 1: 32.02±35.17 mg/L, Group 2: 46.51±46.63 mg/L, P<0.05). Conclusion: Compared to older infants, UTI in neonates and young infants shows milder clinical manifestations except higher rates of hydronephrosis but outcome is alike.
Abstract
Purpose: Although the American Academy of Pediatrics provides clinical guidelines for urinary tract infection (UTI) infants, guidelines are not appropriate for neonates and infants less than 2 months of age due to insufficient data. The aim of this study was to evaluate the characteristics of neonates and young infants less than 2 months old (group 1) with UTI compared to older infants from 2 to 12 months old (group 2). Methods: We reviewed UTI patients aged 0 to 12 months admitted to the pediatric department in the last 5 years. Clinical characteristics such as age, sex, fever duration, recurrence, progression to acute pyelonephritis (APN), malformations like hydronephrosis and vesicoureteral reflux (VUR), and laboratory results were compared between group 1 and group 2. Results: 615 patients were included in this study. Group 1 had 94 cases and group 2 had 521 cases. Escherichia coli was the most commonly isolated pathogen in urine cultures. Fever duration was shorter in group 1 (vs.) 2 (1.91±1.43 days vs. 3.42±2.40 days, P<0.05). As compared to group 2, group 1 had a higher proportion of patients with antenatal hydronephrosis and hydronephrosis found after admission (10.6% vs. 3.6% and 75.5% vs. 55.9%, P<0.05). There were differences between two groups in white blood cell (WBC) count (Group 1: 13,694±5,315/μL, Group 2: 15,271±6,130/μL, P<0.05) and C-reactive protein (Group 1: 32.02±35.17 mg/L, Group 2: 46.51±46.63 mg/L, P<0.05). Conclusion: Compared to older infants, UTI in neonates and young infants shows milder clinical manifestations except higher rates of hydronephrosis but outcome is alike.
참고문헌 (27)
- Mårild S, "Incidence rate of first‐time symptomatic urinary tract infection in children under 6 years of age", Acta Paediatr, 87(5), pp.549~552 (1998)
- Shaikh N, "Prevalence of urinary tract infection in childhood : a meta-analysis", Pediatr Infect Dis J, 27(4), pp.302~308 (2008)
- Elder JS, "Nelson textbook of pediatrics", pp.2556~2562 (2015), Saunders Elsevier
- 이승주, "소아 요로감염의 임상 지침", Korean Journal of Pediatrics, 52(9), pp.976~983 (2009), 대한소아과학회
- Roberts KB, "The epidemiology and clinical presentation of urinary tract infections in children younger than 2 years of age", Pediatr Ann, 28(10), pp.644~649 (1999)
- Roberts KB, "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)
- "Urinary tract infection in children: Diagnosis, treatment and long-term management" (2007)[URL]
- 박규희, "2개월 미만 영아에서의 발열을 동반한 요로감염: 특성과 재발 관련인자", Neonatal medicine, 19(2), pp.91~97 (2012), 대한신생아학회[DOI]
- 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)
- 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)
- Lin DS, "Urinary tract infection in febrile infants younger than eight weeks of age", Pediatrics, 105(2), pp.e20~ (2000)
- Dayan PS, "Clinical course of urinary tract infections in infants younger than 60 days of age", Pediatr Emerg Care, 20(2), pp.85~88 (2004)
- 은병욱, "3개월 이하 영아기 열성 요로감염증에 대한 임상적 관찰", Korean Journal of Pediatrics, 46(3), pp.265~270 (2003), 대한소아과학회
- Ahn HS, "Hong’s Textbook of Pediatrics", pp.910~915 (2012), Mirae &Co
- Fernbach S, "Ultrasound grading of hydronephrosis : introduction to the system used by the Society for Fetal Urology", Pediatr Radiol, 23(6), pp.478~480 (1993)
- Lebowitz R, "International system of radiographic grading of vesicoureteric reflux", Pediatr Radiol, 15(2), pp.105~109 (1985)
- Bachur R, "Nonresponders: prolonged fever among infants with urinary tract infections", Pediatrics, 105(5), pp.e59~ (2000)
- 고희정, "2세 미만 소아의 첫 발열성 요로 감염에서 연령군에따른 발병양상 및 영상의학적 검사 결과의 비교", Childhood Kidney Diseases, 11(2), pp.229~238 (2007), 대한소아신장학회
- Kanellopoulos TA, "First urinary tract infection in neonates, infants and young children: a comparative study", Pediatr Nephrol, 21(8), pp.1131~1137 (2006)
- Timberlake MD, "Mild to moderate postnatal hydronephrosis--grading systems and management", Nat Rev Urol, 10(11), pp.649~656 (2013)
- Coelho GM, "Outcome of isolated antenatal hydronephrosis : a prospective cohort study", Pediatr Nephrol, 22(10), pp.1727~1734 (2007)
- Alconcher LF, "Natural history of bilateral mild isolated antenatal hydronephrosis conservatively managed", Pediatr Nephrol, 27(7), pp.1119~1123 (2012)
- Jakobsson B, "Transient pyelonephritic changes on 99mTechnetium-dimercaptosuccinic acid scan for at least five months after infection", Acta Paediatr, 86(8), pp.803~807 (1997)
- Verber IG, "99mTc dimercaptosuccinic acid(DMSA)scan as first investigation of urinary tract infection", Arch Dis Child, 63(11), pp.1320~1325 (1988)
- 강민주, "6개월 미만 영아의 요로 감염", Korean Journal of Pediatrics, 49(3), pp.278~286 (2006), 대한소아과학회
- Camacho V, "DMSA study performed during febrile urinary tract infection: a predictor of patient outcome?", Eur J Nucl Med Mol Imaging, 31(6), pp.862~866 (2004)
- Koufadaki AM, "Clinical and laboratory indices of severe renal lesions in children with febrile urinary tract infection", Acta Paediatr, 103(9), pp.e404~e409 (2014)