Prediction of Urinary Tract Infection in Neonates with Unexplained Indirect Hyperbilirubinemia

Shaimaa S. Abdelrheem; Hanan Mohammed Aly; Fatma Diab; Ashraf Maebed; Asmaa O. B. Osman; Ahmed H. Mhsb; Nadia K. Alaswad; Taher M. Darwish; Magda Farghali Gabri

doi:10.3889/oamjms.2022.9933

Authors

Shaimaa S. Abdelrheem Department of Public Health and Community Medicine, Faculty of Medicine, Aswan University, Tingar, Egypt; Department of Public Health and Community Medicine, Armed Forces College of Medicine, Cairo, Egypt
Hanan Mohammed Aly Department of Pediatrics, Faculty of Medicine, Aswan University, Tingar, Egypt
Fatma Diab Department of Pediatrics, Faculty of Medicine, Aswan University, Tingar, Egypt
Ashraf Maebed Department of Pediatrics, Faculty of Medicine, Aswan University, Tingar, Egypt
Asmaa O. B. Osman Department of Clinical Pathology, Faculty of Medicine, Assiut University, Asyut, Egypt
Ahmed H. Mhsb Department of Diagnostic Radiology, Faculty of Medicine, Aswan University, Tingar, Egypt
Nadia K. Alaswad Department of Pediatric Nursing, Faculty of Medicine, Cairo University, Cairo, Egypt
Taher M. Darwish aculty of Medicine, Ain Shams University, Cairo, Egypt
Magda Farghali Gabri Department of Pediatrics, Faculty of Medicine, Aswan University, Tingar, Egypt

DOI:

https://doi.org/10.3889/oamjms.2022.9933

Keywords:

Urinary tract infections, Urine culture, Neonatal period, Hyperbilirubinemia

Abstract

Background: Neonates with urinary tract infection (UTI) are susceptible to higher rates of morbidity and mortality, specifically when presented with hyperbilirubinemia. Screening for UTIs in jaundiced neonates is a cost-effective strategy. The aims of this study were to investigate the pattern of UTI (prevalence, etiology, and susceptible antimicrobial agents) in neonates admitted to the NICU with unexplained indirect hyperbilirubinemia, as well as to identify early predictors of UTI in order to reduce the present morbidity and long-term consequences in NICU patients.

. Methods: A cross-sectional hospital-based study that included 140 neonates diagnosed with unexplained indirect hyperbilirubinemia in the first 4 weeks of life. A questionnaire was applied to obtain demographic and clinical data. A number of laboratory parameters were assessed with clinical examination. Bacterial growth of 1 × 10³ colony-forming units/mL of a single uropathogen was used to identify the existence of UTI. Multivariate analysis was used to identify the predicting factors of UTIs. Results: In the NICU group investigated, 25.7% of subjects had a culture-proved UTI. The most frequently isolated organism was Escherichia coli. Amikacin was the most common antibiotic that the isolates were susceptible to. In multivariable logistic regression analysis, a positive urine culture was statistically associated with an increase in WBCs (OR= 6.90, p= 0.001), pyuria (OR= 5.55, p= 0.001), small for gestational age (OR= 4.07, p= 0.021), prolonged phototherapy duration (OR= 3.50, p= 0.034), and the presence of obstetric complications (OR= 2.92, p= 0.001). Conclusion: UTI is substantially prevalent among neonates admitted to the NICU with unexplained indirect hyperbilirubinemia. The importance of routine UTI screening (urine culture) as part of the clinical assessment of unexplained hyperbilirubinemia was highlighted in this study, particularly in neonates with leukocytosis, pyuria, small for gestational age, prolonged phototherapy, and those born from mothers with a history of obstetric complications.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Plum Analytics Artifact Widget Block

References

Morven SE. Postnatal Bacterial Infections. In: Neonatal-Perinatal Medicine. 9th ed. United States: Mosby; 2011.

Kasap B, Soylu A, Kavukçu S. Relation between hyperbilirubinemia and urinary tract infections in the neonatal period. J Nephrol Therapeutic. 2014;S11:009. https://doi.org/10.4172/2161-0959.s11-009 DOI: https://doi.org/10.4172/2161-0959.S11-009

Trihono P, Dewi AC, Gunardi H, Oswari H. Prevalence of urinary tract infection in 2-8-week-old infants with jaundice. Paediatr Indones. 2012;52:304. https://doi.org/10.14238/pi52.5.2012.304-8 DOI: https://doi.org/10.14238/pi52.5.2012.304-8

Ullah S, Rahman K, Hedayati M. Hyperbilirubinemia in neonates: Types, causes, clinical examinations, preventive measures and treatments: A narrative review article. Iran J Public Health. 2016;5(5):558-68.

Mutlu M, Cayır Y, Aslan Y. Urinary tract infections in neonates with jaundice in their first two weeks of life. World J Pediatr. 2014;10:164-7. https://doi.org/10.1007/s12519-013-0433-1 DOI: https://doi.org/10.1007/s12519-013-0433-1

Ambalavanan N, Carlo WA. Jaundice and hyperbilirubinemia in newborn. In: Nelson Textbook of Pediatrics. 20th ed. Netherlands: Elsevier; 2016.

Maamouri GA, Khatami F, Mohammadzadeh A, Saeidi R, Farhat A, Kiani MA, et al. Hyperbilirubinemia and neonatal infection. Int J Pediatr. 2013;1:5-12.

Hernández-Bou S, de la Maza Trenchs VT, Gamarra MA, Díaz JA, Giralt AG, Cubells CL. Etiology and clinical course of urinary tract infections in infants less than 3 months-old. Enferm Infect Microbiol Clin. 2016;33:516-20. https://doi.org/10.1016/j.eimc.2014.11.008 DOI: https://doi.org/10.1016/j.eimc.2014.11.008

Rashed YK, Khtab AA, Alhalaby AM. Hyperbilirubinemia with urinary tract infection in infants younger than eight weeks old. J Pediatr Neonatal Care. 2014;2:101-7. https://doi.org/10.12970/2308-6483.2014.02.03.4 DOI: https://doi.org/10.12970/2308-6483.2014.02.03.4

Sroufe NS, Vredeveld JL, Levy M, Little SH, Schumacher RE, Seagull FJ, et al. Management of Indirect Neonatal Hyperbilirubinemia. Ann Arbor (MI): Michigan Medicine University of Michigan, United States; 2017. https://doi.org/10.1093/pch/pxy054.051

Al-Lawama M, Al-Rimawi E, Al-Shibi R, Badran E. Adoption of the American academy of pediatrics’ neonatal hyperbilirubinemia guidelines and its effect on blood exchange transfusion rate in a tertiary care center in Amman, Jordan. J Blood Med. 2018;9:61-6. https://doi.org/10.2147/JBM.S162191 PMid:29713209 DOI: https://doi.org/10.2147/JBM.S162191

Almohayya TS, Alshabanah RF, Alahmari EM, Almanie NI, Almanie RA, Al Jelban AS, et al. Incidence and risk factors for neonatal jaundice among neonates with urinary tract infection in abha-Saudi Arabia. Egypt J Hosp Med. 2017;67(2):692-6. https://doi.org/10.12816/0037823 DOI: https://doi.org/10.12816/0037823

Moore G, Momoli F, Agarwal A, Agarushi R, Brophy J, Bariciak E. A randomized controlled trial: Suprapubic aspiration versus urinary catheterization in the neonatal intensive care unit. Paediatr Child Health. 2018;23(Suppl 1):20. https://doi.org/10.1093/pch/pxy054.051 DOI: https://doi.org/10.1093/pch/pxy054.051

Jayesh RS, Meshram K. Screening study of dipstick urinalysis of healthy neonates delivered in tertiary care hospital, from Vadodara, Gujarat. Indian J Child Health. 2019;6.10:526-8. https://doi.org/10.32677/ijch.2019.v06.i10.002 DOI: https://doi.org/10.32677/IJCH.2019.v06.i10.002

Glissmeyer EW, Korgenski EK, Wilkes J, Schunk JE, Sheng X, Blaschke AJ, et al. Dipstick screening for urinary tract infection in febrile infants. Pediatrics. 2014;133(5):e1121-7. https://doi.org/10.1542/peds.2013-3291 PMid:24777232 DOI: https://doi.org/10.1542/peds.2013-3291

Jharna M. Pathogenesis and laboratory diagnosis of childhood urinary tract infection. EMJ Urol. 2016;4(1):101-7.

Clinical and Laboratory Standards Institute. Catalogue the Highest Standards for Global Health Care. Clinical and Laboratory Standards Institute; 2019.

Hudzicki J. Kirby-Bauer disk diffusion susceptibility test protocol. American Society of Microbiology; 2012. p. 1-13.

Hansen KL, Nielsen MB, Ewertsen C. Ultrasonography of the kidney: A pictorial review. Diagnostics (Basel). 2015;6(1):2. https://doi.org/10.3390/diagnostics6010002 DOI: https://doi.org/10.3390/diagnostics6010002

Geerlings SE. Clinical presentations and epidemiology of urinary tract infections. Microbiol Spectr. 2016;4(5): 2000-2012. https://doi.org/10.1128/microbiolspec.UTI-0002-2012 DOI: https://doi.org/10.1128/microbiolspec.UTI-0002-2012

Shahian M, Rashtian P, Kalani M. Unexplained neonatal jaundice as an early diagnostic sign of urinary tract infection. Int J Infect Dis. 2012;16(7):e487-90. https://doi.org/10.1016/j.ijid.2012.02.011 DOI: https://doi.org/10.1016/j.ijid.2012.02.011

Nickavar A, Khosravi N, Doaei M. Early prediction of urinary tract infection in neonates with hyperbilirubinemia. J Renal Inj Prev. 2015;4(3):92-5. https://doi.org/10.12861/jrip.2015.18

Aygün E. Clinical significance of urinary tract infection among newborns with hyperbilirubinemia. 2020;9(6):1459. DOI: https://doi.org/10.34297/AJBSR.2020.09.001459

Omar C, Hamza S, Bassem AM, Mariam R. Urinary tract infection and indirect hyperbilirubinemia in newborns. N Am J Med Sci. 2011;3(12):544-7. https://doi.org/10.4297/najms.2011.3544 DOI: https://doi.org/10.4297/najms.2011.3544

Chen HT, Jeng MJ, Soong WJ, Yang CF, Tsao PC, Lee YS, et al. Hyperbilirubinemia with urinary tract infection in infants younger than eight weeks old. J Chin Med Assoc. 2011;74(4):159-63. https://doi.org/10.1016/j.jcma.2011.01.036 PMid:21463845 DOI: https://doi.org/10.1016/j.jcma.2011.01.036

Zarkesh M, Safayi AA, Ramtinfar S, Shakiba M. Incidence of hyperbilirubinemia and urinary tract infection (UTI) in asymptomatic term neonates under two weeks of age. Iran J Neonatol. 2015;6:45-8.

Ozdogan EB, Mutlu M, Camlar SA, Bayramoglu G, Kader S, Aslan Y. Urinary tract infections in neonates with unexplained pathological indirect hyperbilirubinemia: Prevalence and significance. Pediatr Neonatol. 2018;59(3):305-9. https://doi.org/10.1016/j.pedneo.2017.10.010 PMid:29150336 DOI: https://doi.org/10.1016/j.pedneo.2017.10.010

Ozcan M, Sarici S, Yurdugul Y, Akpinar M, Altun D, et al. Association between early idiopathic neonatal jaundice and urinary tract infections. Clin Med Insights Pediatr. 2017;11:1179556517701118. https://doi.org/10.1177/1179556517701118 PMid:28469520 DOI: https://doi.org/10.1177/1179556517701118

Hoseiny NH, Hosseininejad M, Sabooni F, Siadati SA. Relation between urinary tract infection and neonatal icterus. Iran J Pediatr. 2010;2:75-8.

Mohamed W, Algameel A, Bassyouni R, Mahmoud AT. Prevalence and predictors of urinary tract infection in full-term and preterm neonates. Egypt Pediatric Assoc. 2020;Gaz 68:12. https://doi.org/10.1186/s43054-020-00022-2 DOI: https://doi.org/10.1186/s43054-020-00022-2

Blackburn S. Maternal, Fetal, and Neonatal Physiology a Clinical Perspective. 5th ed. Netherlands: Elsevier Health Sciences; 2017.

Malla T, Sathian B, Malla KK, Adhikari S. Urinary tract infection in asymptomatic newborns with prolonged unconjugated hyperbilirubunemia: A hospital-based observational study from the western region of Nepal. Kathmandu Univ Med J. 2016;14(53):41-6. https://doi.org/10.3126/kumj.v13i2.16781 DOI: https://doi.org/10.3126/kumj.v13i2.16781

Arshad M, Seed PC. Urinary tract infections in the infant. Clin Perinatol. 2015;42(1):17-vii. PMid:25677994 DOI: https://doi.org/10.1016/j.clp.2014.10.003

Sproston NR, Ashworth JJ. Role of C-reactive protein at sites of inflammation and infection. Front Immunol. 2018;9:754. https://doi.org/10.3389/fimmu.2018.00754 PMid:29706967 DOI: https://doi.org/10.3389/fimmu.2018.00754

Wise GJ, Schlegel PN. Sterile pyuria. N Engl J Med. 2015;372(11):1048-54. https://doi.org/10.1056/NEJMra1410052 PMid:25760357 DOI: https://doi.org/10.1056/NEJMra1410052

Kibar Y. Current management of urinary tract infection in children. Urinary Tract Infect. 2011;267. https://doi.org/10.5772/23280 DOI: https://doi.org/10.5772/23280