Urinary tract infections in infants: comparison between those with conjugatedvsunconjugated hyperbilirubinaemia

Risk factors for urinary tract infection in infants with unexplained hyperbilirubinemia: a single center case-control study

Background

Urinary tract infection (UTI) is a potential cause of neonatal jaundice. Nevertheless, there remains a lack of consensus regarding appropriate screening practices for UTI in infants with hyperbilirubinemia. This study aimed to analyze a group of jaundiced infants to assess the prevalence of UTI, explore potential risk factors, and examine the impact of UTI on the course and severity of neonatal jaundice.

Methods

This retrospective case-control study was conducted on 150 jaundiced infants (aged < 8 weeks) without a known etiology in the hyperbilirubinemia work-up. All subjects underwent phototherapy treatment and UTI screening by catheterization. They were then classified into UTI and non-UTI groups based on urine culture results, with a positive urine culture indicating the growth of ≥10,000 colony-forming units. The clinical characteristics and jaundice-related parameters of both groups were analyzed.

Results

Among the 150 jaundiced patients, the prevalence of UTI was 29%. There was a significantly higher male predominance in the UTI group, and patients with UTI also had a significantly longer duration of hospitalization compared to those without UTI. Significant risk factors associated with UTI in jaundiced infants included male gender and a peak total bilirubin level higher than 18 mg/dl during hospitalization. The most common pathogens identified in urine culture were Escherichia coli (41.9%) and Enterococcus faecalis (30.2%).

Conclusion

In cases of neonatal jaundice where the underlying cause is not evident, screening for UTI should be performed, particularly when associated risk factors or inadequate response to phototherapy is present.

Unusual Case of an Infant with Urinary Tract Infection Presenting as Cholestatic Jaundice

Neonatal jaundice is considered one of the most common reasons for admission to the pediatric medical ward. We report a case of a 1-month-old infant who presented with jaundice but no fever or any other signs of systemic illnesses. Laboratory test results revealed high direct hyperbilirubinemia, and urine culture showed a urinary tract infection with Enterobacter cloacae as the causative agent. He was admitted to the pediatric medical ward where he was treated with a course of antibiotics for 14 days, and cholestasis resolved completely following a course of antibiotics. We conclude that direct hyperbilirubinemia can be related to urinary tract infection in neonates. It is unusual for urinary tract infection to present clinically and biochemically as cholestatic jaundice.

Association Between Early Idiopathic Neonatal Jaundice and Urinary Tract Infections

Background and purpose:

Etiologic role, incidence, demographic, and response-to-treatment characteristics of urinary tract infection (UTI) among neonates, its relationship with significant neonatal hyperbilirubinemia, and abnormalities of the urinary system were studied in a prospective investigation in early (≤10 days) idiopathic neonatal jaundice in which all other etiologic factors of neonatal hyperbilirubinemia were ruled out.

Patients and methods:

Urine samples for microscopic and bacteriologic examination were obtained with bladder catheterization from 155 newborns with early neonatal jaundice. Newborns with a negative urine culture and with a positive urine culture were defined as group I and group II, respectively, and the 2 groups were compared with each other.

Results:

The incidence of UTI in whole of the study group was 16.7%. Serum total and direct bilirubin levels were statistically significantly higher in group II when compared with group I (P = .005 and P = .001, respectively). Decrease in serum total bilirubin level at the 24th hour of phototherapy was statistically significantly higher in group I compared with group II (P = .022).

Conclusions:

Urinary tract infection should be investigated in the etiologic evaluation of newborns with significant hyperbilirubinemia. The possibility of UTI should be considered in jaundiced newborns who do not respond to phototherapy well or have a prolonged duration of phototherapy treatment.

Early prediction of urinary tract infection in neonates with hyperbilirubinemia

Introduction: Hyperbilirubinemia is a common manifestation of infectious disorders during the neonatal period. Urinary tract infection (UTI) is one of the serious bacterial infections with hyperbilirubinemia among newborn infants.

Objectives: The aim of this study was to identify the early predictive risk factors of UTI in neonates with hyperbilirubinemia, to prevent its long-term complications.

Patients and Methods: A total of 95 neonatal hyperbilirubinemia were evaluated in 2 groups with (n = 40) and without UTI (n = 55).

Results: Mean age at diagnosis of UTI was 16.37 ± 8.86 days. Hyperbilirubinemia was detected in 70% of patients during the first week of life. There was a significant difference regarding the age at admission, duration of hyperbilirubinemia, serum bilirubin and creatinine, white blood cells (WBC) , and also Hgb levels between the 2 groups in univariate analysis. However, prolonged jaundice (OR = 10.3, P = 0.001) and serum bilirubin concentration (OR = 5.15, P = 0.001) were statistically associated with a positive urine culture in multivariate analysis.

Conclusion: Screening of UTI is recommended in neonates with prolonged unexplained jaundice, leukocytosis, and increased serum creatinine.

[Jaundice and urinary tract infection in neonates: simple coincidence or real consequence?]

In neonates, jaundice may be one of the initial symptoms related to urinary tract infection (UTI). The routine testing of the urine in jaundiced neonates is controversial. This study aimed to evaluate the related factors of neonatal infants with the initial presentation of hyperbilirubinemia and the final diagnosis of UTI by evaluating data that help diagnose UTI early in apparently healthy newborns with jaundice.

PATIENTS AND METHODS

We retrospectively investigated the medical records of neonates who had been admitted for management of jaundice (n=26) and compared with neonates with jaundice but without UTI (n=26).

RESULTS

There was a significant difference between the two groups in male gender and maternal conditions (prolonged rupture of membranes, maternal UTI). There was also a significant difference between the two groups in their age at the time jaundice started (4 ± 3 days vs 2 ± 1 days) in the UTI and non-UTI groups, respectively (P>0.05). The cases in the UTI group had significantly lower total bilirubin levels (183 ± 71 mg/l) vs (227 ± 40 mg/l) in the non-UTI group, but a higher indirect bilirubin rate than the non-UTI group (P<0.05). Type B blood group was more common in neonates with UTI (P<0.01). In the cases presented herein, none of the jaundiced infants with UTI presented conjugated hyperbilirubinemia. Therefore, urinary tests for UTI should not be absolutely excluded or neglected in neonates in the early stage with unconjugated hyperbilirubinemia. Performing urinary tests to exclude the possibility of coincidental UTI may be necessary for admitted jaundiced infants younger than if they have a high level of indirect bilirubin, especially in male newborns with group B blood and in the presence of maternal urinary infection.

Bilirubin levels predict renal cortical changes in jaundiced neonates with urinary tract infection

BACKGROUND

This study was undertaken to determine the incidence of urinary tract infection (UTI) and the frequency of anatomical abnormalities in newborns with unexplained jaundice and to find out if there is any correlation between bilirubin level and renal damage.

METHODS

We studied 462 full-term neonates for UTI. They were aged 3-25 days, with either high (>10 mg/dL) or prolonged (>10 days) hyperbilirubinemia, with or without manifestations such as fever, vomiting, diarrhea, poor feeding, lethargy, and irritability. Neonates positive for UTI were further investigated with ultrasound, cystourethrography, and acute phase renal scintigraphy with technetium-99m dimercaptosuccinate acid (DMSA).

RESULTS

Thirty neonates (6.5%) were found to have UTI. Twenty-eight of them had indirect hyperbilirubinemia and two had direct hyperbilirubinemia, with total bilirubin levels of 11.8-20.1 mg/dL. None of the neonates was found to have jaundice because of other reasons such as infection. Vesicoureteral reflux was found in 5 neonates and one of them was combined with hydronephrosis. Renal scintigraphy with technetium-99m DMSA showed renal cortex changes in 14 (46.7%) of the 30 neonates with UTI. These 14 neonates also had increased levels of bilirubin in comparison to those with normal findings of DMSA.

CONCLUSIONS

The incidence of UTI in uncomplicated neonatal jaundice is relatively high. Anatomical abnormalities of the urinary tract are not rare in infected children. Increased bilirubin levels are related to pathological findings in renal scintigraphy.