Question & Answer in neonates Pyelonephritis &UTI

Professor Mohammad H. Soltanzadeh , MD,ID

        Professor of Pediatrics,  Shaheed  Beheshti  University

         Of Medical Sciences  , Tehran , IRAN

Question 1?

A 10-day-old male infant presents with a 2-day history of :

Fever, Vomiting, Lethargy, and Jaundice

Examination reveals :

T. 39 c, BP 65/40 ,P. 170b/m

There are no focal abnormal physical findings .

Laboratory data :

Bilirubin 7 mg/dl

Creatinine 0/2mg/dl

WBC 20000c/mm3

U/A  60 WBC

What is the most likely Diagnosis


The signs & symptoms indicate an acute infectious process.

The Urinalysis suggests a Diagnosis of Pyelonephritis

Symptomatic UTI s occur in 1.4/1000 newborns.

Question  2 ?

What is the incidence of asymptomatic bacteriuria in neonates ?


Asymptomatic bacteriuria occurs in 2 % of healthy term neonates

 And up the 10 % of premature infants

Males are affected more often than females in the neonatal period

Uncircumcised males are even more susceptible .

Question 3 ?

What is the pathogenesis of UTI in the neonate  ?


Unlike older infants

 Hematogenous spread of infection is more common than ascending infection

For this reason

some neonates may have associated meningitis & septicemia


Therefore, in addition to U/A & U/C

Neonates older than 3 days of age :

Should have B/C & CSF/C drawn before the initiation of antibiotics

Unlike the distinction of cystitis & pyelonephritis in older infants & Children

Infection of the UT in the neonate often includes that of the kidney

Question 4 ?

What are the signs & symptoms of UTI in the neonate ?


The symptoms of UTI are often nonspecific & include :

Vomiting & Diarrhea


Fever ,lethargy & jaundice which is unconjugated if the UTI occurs in the 1st wk of life

And cojugated if UTI occurs later

Question 5 ?

How is the diagnosis of the UTI in the neonate ?


The definitive diagnosis is made :

By positive culture of urine is obtained using sterile precaution

The absence of pyuria does not rule out UTI

The diagnosis confirmed by positive U/C by SPA or catheterized specimen with a colony count > 1000 colonies /millimeter

Question 6 ?

What are the common organisms responsible for UTI in newborn infants ?


The mosot common organism causing UTI in neonate is :

E.coli 75- 91% in < 8 wks of age

Other organism include ; proteus




S. aureus


Question 7 ?

How should pyelonephritis be treated ?


Treatment of UTI cosists parenteral antibiotics.

Usually a combination of a :

Penicillin& Amioglycoside

Or Third generation

Amphotrericin is used for Candida infection


The duration of therapy is 10-14 days

Repeat U/C after 48 hrs

Antibiotic prophylaxis is indicated for structural anomalies of the UT or VUR

Prophylaxis is used until spontaneous resolution or

Surgical correction of the underlying lesion has occurred .

Question 8 ?

In addition to U/A & U/C

 what other tests are indicated in the treatment of an infant with possible UTI ?


In addition to diagnosing UTI

It is also important to evaluate the UT for underlying structural or functional abnormalities that may predispose the infant to recurrent UTIs

UT anomalies have been detected 30-55% of infants with UTI< 2 months of age.


Abdominal ultrasound is safe & noninvasive method of evaluating structural abnormalities of the UT & is the initial imaging test of choice .

DMSA can be used to evaluate function & structural abnormalities

VCUG evaluate the presence or absence VUR should be performed after complition of treatmentof the UTI

Home page  | Introduction |  Research Studies  |  Editorships  |  Translations  |  Conferences 

Contact Information  |  Articles  |  Scientific meets & events  |  Research projects  |  Theses