UTI (<3 months)

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Created by
Megan Vann

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Cards (9)

  • Babies will present with very non-specific symptoms:
    • Fever
    • Lethargy
    • Irritability
    • Vomiting
    • Poor feeding
    • Urinary frequency - urine is very rarely discoloured or malodourous
  • Investigation:
    • Urinalysis
    • MC&S
    • Septic screen - blood cultures, lactate
    • Lumbar puncture should be considered (any baby <3 months with fever)
  • Management:
    • All children under 3 months with a fever should start immediate IV antibiotics - usually ampicillin + 3rd generation cephalosporin (e.g. ceftiaxone)
    • Fluids
    • Ultrasound of urinary tract within 6 weeks or during illness if recurrent UTIs or atypical bacteria
    • DMSA scan 4-6 months following infection
  • Imaging schedule for babies < 6 months:
    • Ultrasound during acute infection - atypical or recurrent
    • If not atypical or recurrent - ultrasound within 6 weeks
    • If ultrasound abnormal consider MCUG
    • Otherwise DMSA scan 4-6 months after infection
  • Dimercaptosuccinic acid (DMSA) scan
    • Used 4-6 months after the illness to asses for damage from recurrent or atypical UTIs
    • Inject DMSA (radioactive) and use gamma camera to assess how well the material is taken up by the kidneys
    • Where there are patches of kidney they have not taken up the material, this indicates scarring that may be the result of previous infection
  • Vesico-ureteric reflux:
    • Urine has tendency to flow from the bladder back into the ureters
    • Most commonly presents in infants aged 2 and under after developing UTI
    • Predisposes patients to developing upper UTIs and subsequent renal scarring
    • Diagnosed using micturating cystourethrogram
  • Micturating cystourethrogram (MCUG):
    • Used to investigate atypical or recurrent UTIs in children under 6 months
    • Also used where there is a family history of vesico-ureteric reflux, dilatation of the ureter on US or poor urinary flow
    • Used to diagnose vesico-ureteric reflux
    • Child is catheterised, contrast injected and series of x-rays taken to see if contrast is refluxed into ureters
    • Given prophylactic antibiotics before investigation