Urinary Tract Infections In Children

  • More common in girls than boys except in neonatal period

Presentation

Neonates

  • poor feeding

  • vomiting

  • irritability

  • 'sepsis'

Pre-school Children

  • fever

  • irritability

  • diarrhoea and vomiting

  • suggestive of gastroenteritis

School age children

  • similar to adult picture

  • frequency

  • dysuria

  • suprapubic, loin pain

  • loss of bladder control

Diagnosis

  • stick testing

    • blood

    • protein

    • WBCs

      • in absence bacterial growth may just be result of high fever, appendicitis

    • nitrites

  • culture (>105 cfu /ml clean catch, any in suprapubic aspirate))

Management

  • young infants / neonates - IV broad-spectrum antibiotics

  • antibiotics 5-7 days

  • follow-up investigation

    • ultrasound

    • isotope scanning

    • intravenous urography

    • micturating cystourethrography

    • mag3 cystography

(9) UTI's in children

Any child with a urinary tract infection must be referred to a pediatric urologist for evaluation. Up to 50 percent of these children will have vesicoureteral reflux which, if left untreated, can lead to renal scarring, hypertension, and renal failure. Once the acute infection is cleared with appropriate antibiotic treatment, the child must be placed on prophylactic antibiotics once a day to decrease the risk of a recurrent infection until the work-up is complete. A renal ultrasound should be performed to assess the size of the kidneys as well as the collecting system for dilatation. This study will not, however, rule in or rule out reflux. This must be done with a contrast or nuclear voiding cystourethrogram (VCUG). Bactrim or septra, amoxicillin, cefixime, or nitrofurantoin may be reasonable for prophylaxis. Do not use fluoroquinolones in children due to their association with premature closure of epiphyseal plates.

Any child being evaluated for a febrile illness should be assessed for a urinary tract infection with a urinalysis and culture. Children do not exhibit the classic irritative voiding symptoms as seen in adults with UTIs, but may complain of vague abdominal pain, anorexia, or malaise.