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Yenidoğanda İdrar Yolu Enfeksiyonları

Year 2018, Volume: 12 Issue: 2, 69 - 73, 01.08.2018

Abstract

Amaç: Yenidoğan bebeklerde idrar yolu enfeksiyonunun (İYE) erken tanınması, enfeksiyona bağlı gelişen renal hasar riskini azaltacaktır. Çalışmada, kliniğimizde İYE tanısı ile izlenen yenidoğanlar değerlendirilerek; yenidoğanda İYE klinik ve laboratuvar bulgularının gözden geçirilmesi amaçlanmıştır.Gereç ve Yöntemler: Dr. Behçet Uz Çocuk Hastalıkları ve Cerrahisi Eğitim ve Araştırma Hastanesi Yenidoğan Kliniğinde, Ocak 2014-Ocak 2016 tarihleri arasında İYE tanısı alan ve yatarak incelenen 35 bebek ayrıntılı anamnez, klinik, fizik muayene ve laboratuvar bulguları, poliklinik izlem ve radyoloji sonuçları ile değerlendirilmiştir.Bulgular: Çalışmaya alınan 35 olgunun en sık başvuru yakınması sarılıktır (%45.7, n=16). Olguların idrar tetkikinde %28.5 (n=10) nitrit, % 68.5 (n=24) lökosit deşarjı mevcut olup her ikisinin birlikte olduğu %25.7 (n=9) olgu mevcuttur. Kültür üremesi olan olgularda, idrarda nitrit pozitifliği ve lökosit deşarjı arasında istatistiksel açıdan anlamlı ilişki saptanmıştır (p=0.04). Kateter ve suprapubik yöntemler ile alınan idrar kültürlerinde %42.8 oranı ile (n=15) en sık E.coli üremesi mevcutken, antibiyoterapinin 48. saatinde gönderilen kontrol idrar kültürlerinde ise üreme var ise E.coli’nin extendedspectrum beta lactamase (ESBL) pozitifliği (n=2) öne çıkmıştır. Yüzde on yedi olgu (n=6) antenatal dönemde hidronefroz tanısı almışken, %31.4 olguda (n=11) postnatal renal ultrasonografi (US) ile hidronefroz saptanmıştır; ancak %11.4 olguda (n=4) hem antenatal hem de doğum sonrası yapılan US patolojik bulunmuştur. Kültür üremesi olanlarda, antenatal ve postnatal hidronefroz arasında istatistiksel açıdan anlamlı bir ilişki saptanmıştır (p=0.04).Sonuç: Yenidoğanlarda sarılık, huzursuzluk, kusma gibi non–spesifik bulgular varlığında idrar tetkiki ve idrar kültürü alınmalı, yenidoğan döneminde İYE atlanmamalıdır. Aileler antenatal US takiplerinin önemi konusunda bilinçlendirilmeli ve antenatal dönemde hidronefroz saptanması durumunda, postnatal dönemde henüz İYE geçirmeden yenidoğan ve çocuk nefroloji birimlerince takibe alınmalıdır.

References

  • American Academy of Pediatrics. Committee on Quality Improvement Subcommittee on Urinary Tract Infection. Practice parameter: The diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 1999;103:843-52.
  • Hellerstein H. Urinary tract infections. Old and new concepts. Pediatr Clin North Am 1995;42:1433-57.
  • American Academy of Pediatrics, Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. Diagnosis and management of initial UTIs in febrile infants and children aged 2 to 24 months. Pediatrics 2011;128:595–610.
  • Bilgehan H. Klinik Mikrobiyolojik Tanı. İzmir: Fakülteler Kitabevi, 1995:375-84.

Urinary Tract Infections in Neonates

Year 2018, Volume: 12 Issue: 2, 69 - 73, 01.08.2018

Abstract

Objective: Early diagnosis of urinary tract infection (UTI) in newborn infants will reduce the risk of infection-induced renal damage. Our aim in this study was to evaluate the newborns diagnosed with UTI and observed in our clinic and to review their clinical and laboratory findings.Material and Methods: Infants diagnosed with UTI and observed as inpatients between January 2014 and January 2016 at the Neonatology Clinic of Dr. Behçet Uz Pediatrics and Pediatric Surgery Training and Research Hospital were evaluated with a detailed history, clinical and physical examinations, laboratory findings, clinical observations and radiologic outcomes.Results: There were 35 infants diagnosed with UTI and the most common symptom was jaundice (45.7%, n=16). There were nitrites in 28.5% (n=10) and leucocytes in 68.5% (n=24) on urinalysis and both were present in 25.7% of the cases (n=9). A statistically significant relationship between nitrite positivity and leukocyte presence was found in patients with a positive urine culture (p=0.04). E. coli was the most frequent microorganism with a rate of 42.8% (n=15) in the urine cultures obtained through a urinary catheter or suprapubic aspiration.Extended-spectrum beta lactamase (ESBL) positivity (n=2) of E. coli became prominent if there was positivity in the control urine culture at the 48th hour of antibiotherapy. There were 6 cases (17.1%) diagnosed with hydronephrosis in the antenatal period, and 11 cases (31.4%) diagnosed with hydronephrosis by postnatal renal ultrasonography (US). However, only 4 cases (11.4%) had pathologic findings both with antenatal and postnatal US. A statistically significant relationship between antenatal and postnatal hydronephrosis was detected in patients with a positive culture (p<0.05).Conclusion: In the neonatal period, UTI has nonspecific symptoms such as jaundice, irritability and vomiting. If there is a suspicion of UTI in a newborn, urinalysis and urine culture should be requested and the infection should not be overlooked. Families should be aware of the importance of antenatal follow-up by US and the postnatal follow-up of infants by the neonatology and pediatric nephrology departments before suffering a UTI

References

  • American Academy of Pediatrics. Committee on Quality Improvement Subcommittee on Urinary Tract Infection. Practice parameter: The diagnosis, treatment, and evaluation of the initial urinary tract infection in febrile infants and young children. Pediatrics 1999;103:843-52.
  • Hellerstein H. Urinary tract infections. Old and new concepts. Pediatr Clin North Am 1995;42:1433-57.
  • American Academy of Pediatrics, Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. Diagnosis and management of initial UTIs in febrile infants and children aged 2 to 24 months. Pediatrics 2011;128:595–610.
  • Bilgehan H. Klinik Mikrobiyolojik Tanı. İzmir: Fakülteler Kitabevi, 1995:375-84.
There are 4 citations in total.

Details

Other ID JA88DA43AB
Journal Section Research Article
Authors

Ezgi Yangın Ergon This is me

Buğra Han Acar This is me

Kıymet Çelik This is me

Rüya Çolak This is me

Senem Alkan Özdemir This is me

Şükran Keskin Gözmen This is me

Özgür Olukman This is me

Erkin Serdaroğlu This is me

Şebnem Çalkavur This is me

Publication Date August 1, 2018
Submission Date August 1, 2018
Published in Issue Year 2018 Volume: 12 Issue: 2

Cite

Vancouver Ergon EY, Acar BH, Çelik K, Çolak R, Özdemir SA, Gözmen ŞK, Olukman Ö, Serdaroğlu E, Çalkavur Ş. Urinary Tract Infections in Neonates. Türkiye Çocuk Hast Derg. 2018;12(2):69-73.


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