İdrar yolu enfeksiyonlu yenidoğan bebeklerin değerlendirilmesi

Öz

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.

Anahtar Kelimeler

• Yenidoğan
• idrar yolu enfeksiyonu
• görüntüleme

Evaluation of the newborns with urinary tract infection

Öz

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.

Anahtar Kelimeler

• Newborn
• urinary tract infection
• imaging

Kaynakça

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