PEDIATRICS Vol. 109 No. 5 May 2002, pp. 846-851
Jaundice as an Early Diagnostic Sign of Urinary Tract Infection in Infancy
From the Division of Emergency and Transport Medicine, Childrens Hospital Los Angeles, Los Angeles, California; and the Keck School of Medicine of the University of Southern California, Los Angeles, California
or fgarcia{at}chla.usc.edu
--> Objective. Urinary tract infections (UTIs) are a common clinical problem in febrile infants younger than 8 weeks old, with a prevalence between 5% and 11%. Previous studies have noted that jaundice may be one of the first signs of a bacterial infection in infants. Our goal was to determine the incidence of UTIs in asymptomatic, jaundiced infants younger than 8 weeks old and to determine which historical and laboratory parameters are associated with UTIs.
Methods. We prospectively evaluated asymptomatic, jaundiced infants younger than 8 weeks old for evidence of a UTI (defined as >10 000 colony-forming units per milliliter of a single pathogen, obtained by bladder catheterization). A serum fractionated bilirubin level was obtained on all study patients. Detailed questionnaires were completed, which included demographic information, prenatal, intrapartum, and postnatal events.
Results. Twelve (7.5%) of 160 infants had a UTI (95% confidence interval: 3.9%–12.7%). Isolated organisms included Escherichia coli, Enterobacter cloacae, Enterococcus, Klebsiella pneumoniae, group B Streptococcus, Streptococcus viridans, and Staphylococcus aureus. Patients with the onset of jaundice after 8 days of age had a higher incidence of UTI, 6 (50%) of 12 infants in the positive culture group, versus 15 (10%) of 148 infants in the negative culture group. Abnormal urinalysis and microscopy results were noted in 5 (42%) of 12 infants with a UTI, and 6 (55%) of 11 infants had abnormal renal ultrasound results.
Conclusion. A UTI was found in 7.5% of asymptomatic, afebrile, jaundiced infants younger than 8 weeks old. In addition, infants with the onset of jaundice after 8 days of age or patients with an elevated conjugated bilirubin fraction were more likely to have a UTI. Therefore, we recommend that testing for a UTI be included as part of the evaluation in asymptomatic, jaundiced infants presenting to the emergency department.
Key Words: urinary tract infection • jaundice • hyperbilirubinemia • neonatal infection
Abbreviations: AAP, American Academy of Pediatrics • UTI, urinary tract infection • ED, emergency department • HPF, high-power field • WBC, white blood cell
Received for publication May 14, 2001; Accepted Oct 8, 2001.
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