Urinary Tract Infections

5/9/2008

A urinary tract infection, or UTI, can be difficult to detect in children too young to be able to describe problems like painful urination in words. That’s why so many UTIs in children under two are discovered when investigating a fever that’s lasted too long, an inexplicably irritable baby, or a baby with very poor weight gain or failure to thrive.

Unfortunately, children this age are at the highest risk for serious complications and require an extensive follow-through.

What’s the work-up?

A pediatrician who suspects a UTI will collect a urine specimen for two tests:

• A dipstick analysis done right away in the office to spot suspicious elements, like white or red blood cells in the urine. If a bacterial infection appears likely based on findings of the dipstick analysis, antibiotics can be prescribed at once.
• A 48-hour bacterial culture done at an off-site laboratory to identify the bacterium involved. If necessary, an antibiotic more effective against that specific organism can then be prescribed.

What’s the follow-up?

Once the infection is resolved, current American Academy of Pediatrics (AAP) guidelines advise that any child under two years old with a fever and urinary infection undergo two studies:

• a sonogram (ultrasound) of the kidneys and bladder by a radiologist to view the overall anatomy of the urinary tract, looking for abnormalities in the structure of the bladder, ureters, and kidneys.
• a voiding cystourethrogram (VCUG) by a pediatric radiologist to check the function of the bladder and ureters. An x-ray is taken as a small amount of nontoxic dye is injected through a small catheter gently passed through the urethra into the bladder. A second x-ray is taken after the child empties her bladder. The doctor will be looking to see if any dye shows up in the ureters, the tubes that drain urine from the kidneys to the bladder. This is a sign of urinary reflux, the flow of urine back towards the kidneys instead out through the bladder.

It is important to treat urinary reflux, because, over time untreated reflux can lead to scarring of the ureters and kidneys.

The treatment of urinary reflux depends on its severity. A small number of children will need surgical treatment. But for most kids the treatment for urinary reflux is a long course of low-dose antibiotics to suppress bacteria and simple observation by a pediatric urologist and the child’s pediatrician. Don’t forget to supplement the child’s diet with probiotics during antibiotic treatment to maintain healthy intestinal function. Urinary reflux generally resolves by the time a child is two, once the urinary structures have grown and their function has properly matured.

The abnormalities that cause urinary reflux tend to run in families, so current recommendations advise that once one child in a family has been diagnosed with urinary reflux all future children be screened with a VCUG immediately after birth.