Urinary Tract Infection (UTI) in children

Urinary tract is the second most common site of infection in children. Young children and infants present with very few signs and symptoms specific to urinary tract infection [UTI]. Most commonly pain while passing urine, dribbling of urine, increased urine frequency and sometimes blood in the urine are seen. Although poor feeding and vomiting are quite common, high fever and pain in the loin are seen in severe urine infections (Pyelonephitis). Detailed history and thorough examination, especially genital regions are important.

Urinary Tract Infection (UTI) in children

Urine analysis/dipstick is the first test usually done. If urine infection is present, usually pus cells and nitrites are positive in the test. The method of urine collection has to be very clean. Unclean methods of urine collection, improper containers, and leaving urine sample outside for too long, can all give false positive results.

Routine Blood tests like complete blood count (CBC), inflammation markers (Eg: CRP) and kidney function tests are sometimes done to see if the urine infection has spread to other parts of the body or how severe the infection is.

Ultrasound scan [USS] is the next test commonly done test in children. It can provide a lot of details on kidneys and urinary bladder. Surgical abnormalities of urinary tract are found on ultrasound scan in almost a third of the children diagnosed with UTI. Further tests like Micturating cystourethrogram [MCUG], DMSA, and DTPA scans may be done to help us arrive on the correct diagnosis and in detailed assessment of kidney function. This will guide on the further treatments or surgery.

Luckily, most urine infections are not severe and easily respond to oral antibiotics. But if patient has high fever or becomes unwell, oral antibiotics (Syrups) are not enough. Admission to hospital is needed with antibiotics given through intravenous route.

Infants and female children have a higher risk for urinary tract infection. However, there are other several risk factors that increase the risk in children to urinary tract infection [Table 1]. Repeated urine infections can lead to loss of kidney function. However, in infants and young children a single episode of urine infection is sometimes enough to cause severe kidney damage. As a result scarring of kidneys, kidney failure and high blood pressure may follow.

Early diagnosis and appropriate management of urinary tract infection is therefore important. The NICE guidelines developed in UK for UTI in children details the importance of correct diagnosis and with appropriate tests and treatment. Although these guidelines are evidence based, individual patient presentations vary and may need further tests and surgery.

Table 1. Risk Factors for UTI in children

Infants (< 1 year age)
Girls above 1 year of age
Structural problems of urinary tract
     - VUR
     - Bladder outlet obstruction
     - Posterior urethral valves (boys only)
     - Bladder diverticulum
     - Ectopic ureters
Functional problems of urinary tract
     - Neuropathic bladder
     - Dysfunctional voiding
     - Bowel bladder dysfunction
Catherisation and instrumentations of urinary tract

Article by Dr. Sivashankar Jayakumar
Pediatric & Neonatal Surgeon
Kauvery Hospital, Chennai

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