Question & Answer in neonates Pyelonephritis
Mohammad H. Soltanzadeh , MD,ID
Professor of Pediatrics, Shaheed Beheshti
Of Medical Sciences , Tehran ,
A 10-day-old male infant presents with a 2-day history of :
Fever, Vomiting, Lethargy, and Jaundice
Examination reveals :
T. 39 c, BP 65/40 ,P. 170b/m
There are no focal abnormal physical findings .
Laboratory data :
Bilirubin 7 mg/dl
U/A 60 WBC
What is the most likely Diagnosis
The signs & symptoms indicate an acute infectious process.
The Urinalysis suggests a Diagnosis of Pyelonephritis
Symptomatic UTI s occur in 1.4/1000 newborns.
Question 2 ?
What is the incidence of asymptomatic bacteriuria in neonates ?
Asymptomatic bacteriuria occurs in 2 % of healthy term neonates
And up the 10 % of premature infants
Males are affected more often than females in the neonatal period
Uncircumcised males are even more susceptible .
Question 3 ?
What is the pathogenesis of UTI in the neonate ?
Unlike older infants
Hematogenous spread of infection is more common than ascending
For this reason
some neonates may have associated meningitis & septicemia
Therefore, in addition to U/A & U/C
Neonates older than 3 days of age :
Should have B/C & CSF/C drawn before the initiation of antibiotics
Unlike the distinction of cystitis & pyelonephritis in older infants
Infection of the UT in the neonate often includes that of the kidney
Question 4 ?
What are the signs & symptoms of UTI in the neonate ?
The symptoms of UTI are often nonspecific & include :
Vomiting & Diarrhea
Fever ,lethargy & jaundice which is unconjugated if the UTI occurs
in the 1st wk of life
And cojugated if UTI occurs later
Question 5 ?
How is the diagnosis of the UTI in the neonate ?
The definitive diagnosis is made :
By positive culture of urine is obtained using sterile precaution
The absence of pyuria does not rule out UTI
The diagnosis confirmed by positive U/C by SPA or catheterized
specimen with a colony count > 1000 colonies /millimeter
Question 6 ?
What are the common organisms responsible for UTI in newborn
The mosot common organism causing UTI in neonate is :
E.coli 75- 91% in < 8 wks of age
Other organism include ; proteus
Question 7 ?
How should pyelonephritis be treated ?
Treatment of UTI cosists parenteral antibiotics.
Usually a combination of a :
Or Third generation
Amphotrericin is used for Candida infection
The duration of therapy is 10-14 days
Repeat U/C after 48 hrs
Antibiotic prophylaxis is indicated for structural anomalies of the
UT or VUR
Prophylaxis is used until spontaneous resolution or
Surgical correction of the underlying lesion has occurred .
Question 8 ?
In addition to U/A & U/C
what other tests are indicated in the treatment of an infant with
possible UTI ?
In addition to diagnosing UTI
It is also important to evaluate the UT for underlying structural or
functional abnormalities that may predispose the infant to recurrent
UT anomalies have been detected 30-55% of infants with UTI< 2 months
Abdominal ultrasound is safe & noninvasive method of evaluating
structural abnormalities of the UT & is the initial imaging test of
DMSA can be used to evaluate function & structural abnormalities
VCUG evaluate the presence or absence VUR should be performed after
complition of treatmentof the UTI