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PEDIATRICS Vol. 112 No. 5 November 2003, pp. 1212-1213

Neonatal Jaundice Coinciding With or Resulting From Urinary Tract Infections?

S. Ü. Sarici, MD
Mustafa Kul, MD
Faruk Alpay, MD
Division of Neonatology, Department of Pediatrics, Gülhane Military Medical Academy, Ankara, Turkey

To the Editor.—

We have read with great interest the article by Garcia and Nager,¹ in which they investigated the diagnostic role of jaundice in neonatal urinary tract infections (UTIs). The authors touched on a very interesting topic as the pathophysiological relationship between UTI and jaundice has not exactly been demonstrated yet and pediatricians and neonatal practitioners not infrequently encounter neonatal unconjugated, and especially persistent, jaundice coinciding with or resulting from UTI in clinical practice. However, we have some critical comments regarding the design and conclusions of the study.

In such a study aiming primarily to determine the association of unexplained hyperbilirubinemia with UTIs, the main weakness is lack of a control group merely consisting of newborns without jaundice. Considering relatively higher (7.5%) incidence of a UTI in asymptomatic, afebrile, jaundiced infants younger than 8 weeks old, the prevalence of UTI in age-matched and healthy infants without jaundice in the same population needs to be demonstrated. Furthermore, if total bilirubin levels were not higher in patients with UTIs as compared with subjects with negative urine cultures, although mean serum total bilirubin levels were not given, how could the authors conclude that jaundice is one of the first symptoms of UTI? In the absence of an unjaundiced control group and considering the significant differences in conjugated bilirubin fraction and insignificant differences in mean serum bilirubin levels between infants with and without UTI, one could not easily conclude that UTIs are more common in jaundiced infants than in any population given, but would only conclude that conjugated hyperbilirubinemia is more commonly observed in jaundiced infants who have UTI when compared with infants with jaundice but without UTI.

REFERENCE

1. Garcia FJ, Nager AL. Jaundice as an early diagnostic sign of urinary tract infection in infancy. Pediatrics.2002; 109 :846 –851[Abstract/Free Full Text]

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Francisco J. Garcia, MD
Alan L. Nager, MD
Kapiolani Medical Center for Women and Children, Division of Emergency Medicine, Honolulu, HI 96826, USA
Childrens Hospital Los Angeles, Division of Emergency and Transport Medicine, Los Angeles, CA 90027, USA

In Reply.—

We appreciate the correspondents’ interest and comments on our article. We disagree with their point that the main weakness of the study is a lack of a control group, namely newborns without jaundice. Sarici et al suggest that the prevalence of UTI in age-matched and healthy infants without jaundice in the same population needs to be demonstrated. Previous studies by Abbott,¹ Edelman et al,² and Wettergren et al³ have demonstrated the prevalence of positive urine culture in symptom-free infants or in patients with "asymptomatic bacteriuria" to be <1%. Ethically, catheterizing the bladder of a control group of asymptomatic, age-matched, and healthy infants without jaundice was not felt to be reasonable or risk-free.

Sarici et al ask, "If total bilirubin levels were not higher in patients with UTIs as compared with subjects with negative urine cultures, how could the authors conclude that jaundice is one of the first symptoms of UTI?" Our attempt in this descriptive study was to find those factors associated with jaundice and UTI, because physiologic and breastfeeding jaundice are clinical diagnoses and not necessarily distinct or different from jaundice with infections. We agree with Sarici et al that conjugated hyperbilirubinemia seems to be more commonly observed in patients with a UTI according to our study findings.

REFERENCES

1. Abbott GD. Neonatal bacteriuria: a prospective study of 1460 infants. BMJ.1972; 1 :267 –269
2. Edelman CM, Ogwo JE, Fine BP, Martinez AB. The prevalence of bacteriuria in full-term and premature newborn infants. J Pediatr.1973; 82 :125 –132[CrossRef][Web of Science][Medline]
3. Wettergren B, Jodal U, Jonasson G. Epidemiology of bacteriuria during the first year of life. Acta Paediatr Scand.1985; 74 :925 –933[Web of Science][Medline]

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PEDIATRICS (ISSN 1098-4275). ©2003 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Web of Science (2) Citing Articles via Google Scholar Google Scholar Articles by Sarici, S. U. Articles by Nager, A. L. Search for Related Content PubMed PubMed Citation Articles by Sarici, S. U. Articles by Nager, A. L. Related Collections Miscellaneous Social Bookmarking                         What's this?