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Category: Volume 07 Issue 10 October 2019
Hits: 1921

Title: Jaundice as sign of Urinary Tract Infection in Early Infancy: A hospital based Observational study

Authors: Neupane Shankar, Sharma Arun Kumar, Shrestha Laxman, Subedi Sonika

 DOI: https://dx.doi.org/10.18535/jmscr/v7i10.46

Abstract

  

Background: Neonatal jaundice is a common problem and often warrants extensive evaluation. Bacterial infections in neonates including urinary tract infection (UTI) can manifest with jaundice. Guidelines on management of afebrile, asymptomatic jaundiced infants do not necessarily include evaluation of UTI. The aim of this study was to determine the incidence of UTI in asymptomatic, jaundiced infants younger than 8 weeks old.

Methods: Significantly jaundiced infants aged 4 days to 8 weeks and born at ≥35 weeks of gestation who were otherwise well in outpatient and inpatient settings were prospectively included in the study. Infants were significantly jaundiced if they had jaundice visualized up to Kramer’s dermal zone 4 or 5 in first two weeks of life and/or jaundice prolonged beyond first two weeks of age. All significantly jaundiced infants underwent suprapubic aspiration for urine collection and UTI was diagnosed with isolation of any organism in the sample. A serum fractionated bilirubin level was obtained on all cases. All infants underwent other relevant investigations as indicated. A standardized questionnaire was completed to determine the relationship with demographic features and prenatal, intranatal, and postnatal events.

Results: One hundred and twenty-six infants, 81 (64.3%) of whom were boys were enrolled at a mean age of 16±14 days. Most of the neonates (118, 93.7%) had onset of jaundice within 4-14 days of life. Only one out of 126 infants (0.8%) had a diagnosis of UTI, Escherichia coli was isolated as a causative organism. Etiology of jaundice was established as breast milk jaundice in majority of infants (122, 96.8%). Since there was a single patient with UTI, the influence of various risk factors upon incidence of UTI could not be analyzed.

Conclusion: A very low incidence of UTI was identified in infants with jaundice. The study failed to show significant association between jaundice and UTI. Routine evaluation for UTI may not be suggested in asymptomatic jaundiced neonates. Further studies in larger population should be performed to determine if newborns with asymptomatic jaundice require routine evaluation for UTI.

Keywords: Jaundice, Urinary Tract Infection, Infant, Kramer’s dermal zone.

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Corresponding Author

Neupane Shankar

Shankarapur Hospital, Kathmandu, Nepal