Document Detail

Urinary tract infection in premature infants: the role of imaging studies and prophylactic therapy.
MedLine Citation:
PMID:  9280097     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The prevalence of urinary tract infection (UTI) in premature infants ranges from 4% to 25%. It is surprising, however, that scant information exists regarding management of UTI in premature infants, particularly the need for radiologic evaluation of the urinary tract and the use of preventive antibiotic therapy after the first episode of UTI occurs. The aim of this study was to answer these questions. PATIENTS AND METHODS: Twenty-seven (8%) premature infants (< 1750 gm birth weight) born during the period from 1990 through 1993 had UTI. Eleven of them were of extreme low birth weight (ELBW) (birth weight < 1000 gm). Ultrasound examination of the urinary tract was performed in all premature infants 7 days after a diagnosis of UTI was made and was repeated 1 month later, if disease was detected. Voiding cystography was performed in 21 premature infants (8 with ELBW) 6 to 8 weeks after a diagnosis of UTI was made. RESULTS: The mean birth weight of premature infants with UTI was 1112 +/- 294 gm. The prevalence of UTI was significantly higher (p < 0.01) in infants with ELBW (13%) compared with that in premature infants with birth weight >1000 gm (6%). The male/female ratio in all premature infants was 2.9:1 and was significantly higher in infants with ELBW (10:1; p < 0.01). Organisms involved were Klebsiella (59%), Candida albicans (15%), Escherichia coli (15%), and Enterobacter (11%). Only premature infants with ELBW had Candida UTI. Five premature infants (four with ELBW) had mild transient hydronephronis, and one had persistent hydronephrosis and hydroureter. Voiding cystography showed that three premature infants had vesicoureteral reflux and that one had a bladder diverticulum. All premature infants with pathologic voiding cystography had birth weight >1000 gm and had normal ultrasound examination. CONCLUSIONS: Premature infants with birth weight 1000 to 1750 gm should be given preventive antibiotic therapy at least until imaging evaluation (ultrasonography and voiding cystography) is complete. Premature infants with ELBW are more susceptible to fungal infection and do not seem to have underlying urinary tract abnormalities. Prophylactic therapy and voiding cystography may be unwarranted in this population subset.
A Eliakim; T Dolfin; Z Korzets; B Wolach; A Pomeranz
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of perinatology : official journal of the California Perinatal Association     Volume:  17     ISSN:  0743-8346     ISO Abbreviation:  J Perinatol     Publication Date:    1997 Jul-Aug
Date Detail:
Created Date:  1997-10-09     Completed Date:  1997-10-09     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  8501884     Medline TA:  J Perinatol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  305-8     Citation Subset:  IM    
Department of Pediatrics, Meir General Hospital, Kfar Saba, Israel.
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MeSH Terms
Anti-Bacterial Agents / therapeutic use
Bacterial Infections / complications
Birth Weight
Infant, Low Birth Weight
Infant, Newborn
Infant, Newborn, Diseases / diagnosis*,  prevention & control*
Infant, Premature*
Kidney / ultrasonography
Mycoses / complications
Urinary Tract Infections / diagnosis*,  microbiology,  prevention & control*
Reg. No./Substance:
0/Anti-Bacterial Agents

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