İdrar yolu enfeksiyonlu yenidoğan bebeklerin değerlendirilmesi

Abstract

Amaç: Yenidoğan ünitesinde idrar yolu enfeksiyonu (İYE) tanısıyla izlenen bebeklerin retrospektif değerlendirilmesi.
Gereç ve yöntem: 2015-2019 yılları arasında yenidoğan ünitemizde İYE tanısıyla (sonda ile alınan idrar kültüründe >10,000 cfu/ml mikroorganizma üremesi) izlenen 50 yenidoğan bebeğin klinik, laboratuvar bulguları ve prenatal-postnatal görüntülemeleri değerlendirildi.
Bulgular: Çalışmaya alınan 50 olgunun 23’ü kız ve 27’si erkekti. Gebelik yaşları ortalamaları 34,3±4,6 haftaydı (minimum-maksimum:23-41). Çoğu olgu (n=42, %84) gebelik yaşına göre normal ağırlıktaydı. Yirmi (%40) olgu asemptomatikken, 30’u (%60) semptomatikti. Term bebeklerde ateş, prematürelerde apne daha sıktı. İdrar kültürlerinde en sık E.coli (n=24, %48) ve klebsiella pneumoniae (n=13, %26) üremesi saptandı. Eş zamanlı alınan kan kültürlerinin %24’ünde (n=12) üreme (koagülaz negatif stafilokok n=8, %16) saptandı. Olguların tümü postnatal üriner sistem ultrasonografiyle değerlendirildiğinde; %68’i (n=34) normal, %32’si (n=16) anormal (n=5, %31,2 hidronefroz; n=10, %68,8 nefrolitiazis, n=1, pelvikalisiyel ektazi) bulundu. Ultrason bulgusu anormal olan ve voiding sistoüretrografi yapılan 12 olgunun yarısında (n=6, %50) vezikoüreteral reflü saptandı.
Sonuç: Yenidoğan ünitesinde İYE saptanan bebeklerin %40’ı asemptomatikken %60 semptomatikti ve idrar kültüründe en sık E.coli üredi. Bu olguların yaklaşık 1/3’ünde postnatal üriner sistem ultrasonuyla anormal bulgu, ultrasonu anormal olanların %31,2’sinde hidronefroz ve hidronefroz tanımlananların tamamında ileri derecede vezikoüreteral reflü saptandı. Sonuç olarak, İYE saptanan yenidoğanlar eşlik edebilecek üriner sistem malformasyonu açısından mutlaka ultrason ile değerlendirilmeli ve hidronefroz saptananlar vezikoüreteral reflü açısından araştırılmalıdır.

Keywords

• Yenidoğan
• idrar yolu enfeksiyonu
• görüntüleme

Evaluation of the newborns with urinary tract infection

Abstract

Purpose: Retrospective evaluation of infants followed up with the diagnosis of urinary tract infection (UTI) in the neonatal unit. Materials and methods: The clinical, laboratory findings and prenatal-postnatal imaging of 50 newborns followed up between 2015 and 2019 in our neonatal unit with the diagnosis of UTI (>10,000 cfu/ml microorganism growth in urine-culture taken via catheter) were evaluated. Results: Of 50 cases included in the study, 23 were female and 27 were male. Mean gestational-age was 34.3±4.6 weeks (minimum-maximum:23-41). Most cases (n=42, 84%) were normal weight for gestational-age.Twenty(40%) cases were asymptomatic, while thirty(60%) were symptomatic. Fever was more common in term infants, apnea was more common in preterms. E.coli growth (48%, n=24) and Klepsiella pneumoniae (26%, n=13) were frequently detected in urine-cultures. 12 (24%) of blood-cultures taken simultaneously were positive (16% for coagulase-negative-staphylococci, n=8). All cases were evaluated with postnatal urinary-system ultrasonography (USG); While 16 (32%) abnormal findings (n=5, 31.2% hydronephrosis; n=10, 68.8% nephrolithiasis, pelvicalyceal ectasia) were detected, 34 (68%) were normal. Vesicoureteral-reflux (VUR) was detected in half of 12 cases (n=6, 50%) had abnormal ultrasound findings and underwent voiding-cysto-ureterography. Conclusion: While 40% of infants found to have UTI in the neonatal unit were asymptomatic, 60% were symptomatic, and E.coli growth was often observed in urine-culture. Postnatal urinary-system USG revealed abnormal findings in approximately 1/3 of these cases, hydronephrosis in 31.2% of them, and advanced VUR in all of hydronephrosis. In conclusion, newborns with UTI should be evaluated with ultrasound in terms of urinary-system malformation that may accompany, and those with hydronephrosis should be investigated for vesicoureteral-reflux.

Keywords

• Newborn
• urinary tract infection
• imaging

References

1. 1. Mahant S, Friedman J, MacArthur C. Renal ultrasound findings and vesicoureteral reflux in children hospitalised with urinary tract infection. Arch Dis Child 2002;86(6):419-420. doi:10.1136/adc.86.6.419
2. 2. Weems MF, Wei D, Ramanathan R, Barton L, Vachon L, Sardesai S. Urinary tract infections in a neonatal intensive care unit. Am J Perinatol 2015;32(7):695-702. doi:10.1055/s-0034-1395474
3. 3. Bauer S, Eliakim A, Pomeranz A, et al. Urinary tract infection in very low birth weight preterm infants. Pediatr Infect Dis J 2003;22(5):426-430. doi:10.1097/01.inf.0000065690.64686.c9
4. 4. Bonadio W, Maida G. Urinary tract infection in outpatient febrile infants younger than 30 days of age: a 10-year evaluation. Pediatr Infect Dis J 2014;33(4):342-344. doi:10.1097/INF.0000000000000110
5. 5. Roberts KB. Subcommittee on urinary tract infection, steering committee on quality improvement and management. 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 2011;128(3):595-610. doi:10.1542/peds.2011-1330
6. 6. Cataldi L, Zaffanello M, Gnarra M, Fanos V, Neonatal Nephrology Study Group, Italian Society of Neonatology. Urinary tract infection in the newborn and the infant: state of the art. J Matern Fetal Neonatal Med 2010;23 Suppl 3:90-93. doi:10.3109/14767058.2010.513851
7. 7. Foglia EE, Lorch SA. Clinical predictors of urinary tract infection in the neonatal intensive care unit. J Neonatal Perinatal Med 2012;5(4):327-333. doi:10.3233/NPM-1262812
8. 8. Leonard EG, Dobbs K. Postnatal bacterial infecitons. In: Martin RJ, Fanaroff AA, Walsh MC, eds. Fanaroff and Martin’s neonatal-perinatal medicine, diseases of the fetus and infant. 10th ed. Philadelphia: Elsevier Saunders, 2015;734-750.

9. 9. Walawender L, Hains DS, Schwaderer AL. Diagnosis and imaging of neonatal UTIs. Pediatr Neonatol 2020;61(2):195-200. doi:10.1016/j.pedneo.2019.10.003
10. 10. Littlewood JM. 66 infants with urinary tract infection in first month of life. Arch Dis Child 1972;47(252):218-226. doi:10.1136/adc.47.252.218
11. 11. Hooton TM, Scholes D, Hughes JP, et al. A prospective study of risk factors for symptomatic urinary tract infection in young women. N Engl J Med 1996;335(7):468-474. doi:10.1056/NEJM199608153350703
12. 12. American Academy of Pediatrics Subcommittee on Hyperbilirubinemia. Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation [published correction appears in Pediatrics. 2004 Oct;114(4):1138]. Pediatrics 2004;114(1):297-316. doi:10.1542/peds.114.1.297
13. 13. Tzimenatos L, Mahajan P, Dayan PS, et al. Accuracy of the urinalysis for urinary tract infections in febrile infants 60 days and younger. Pediatrics 2018;141(2):e20173068. doi:10.1542/peds.2017-3068
14. 14. Hoberman A, Wald ER, Reynolds EA, Penchansky L, Charron M. Pyuria and bacteriuria in urine specimens obtained by catheter from young children with fever. J Pediatr 1994;124(4):513-519. doi:10.1016/s0022-3476(05)83127-0
15. 15. Wallace SS, Zhang W, Mahmood NF, et al. Renal ultrasound for infants younger than 2 months with a febrile urinary tract infection. AJR Am J Roentgenol 2015;205(4):894-898. doi:10.2214/AJR.15.14424
16. 16. Sastre JB, Aparicio AR, Cotallo GD, Colomer BF, Hernández MC, Grupo de Hospitales Castrillo. Urinary tract infection in the newborn: clinical and radio imaging studies. Pediatr Nephrol 2007;22(10):1735-1741. doi:10.1007/s00467-007-0556-5
17. 17. Arshad M, Seed PC. Urinary tract infections in the infant. Clin Perinatol 2015;42(1):17-vii. doi:10.1016/j.clp.2014.10.003