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Predictors of grade 3–5 vesicoureteral reflux in infants ≤ 2 months of age with pyelonephritis

  • Hilla Bahat
  • Mai Ben-Ari
  • Tomer Ziv-Baran
  • Amos Neheman
  • Ilan Youngster
  • Michael Goldman
Original Article

Abstract

Background

This study aimed to assess predictors for grade 3–5 vesicoureteral reflux (VUR) in infants ≤ 2 months of age admitted for first urinary tract infection (UTI).

Methods

Retrospective cohort study of 195 infants ≤ 2 months admitted to a pediatric ward for first UTI between 2006 and 2017. Clinical, laboratory, and imaging data were collected from electronic medical charts. We examined associations between grade 3–5 VUR and different patient characteristics.

Results

Twenty infants (10%) were diagnosed with grade 3–5 VUR; all had fever. Infants with grade 3–5 VUR had higher blood neutrophil percentage (BNP) (65% vs. 46%, P < 0.001), higher neutrophil-to-lymphocyte ratio (NLR) (2.6 vs. 1.3, P < 0.001), more renal ultrasound abnormalities (prenatal 26% vs. 5%, P = 0.007; postnatal 84% vs. 55%, P = 0.015), and Pseudomonas UTI (15% vs. 1%, respectively, P < 0.001). NLR > 1.65 showed sensitivity 100% and specificity 61% for detecting grade 3–5 VUR. BNP > 53% showed sensitivity 100% and specificity 60% for detecting grade 3–5 VUR. BNP was the best single marker for grade 3–5 VUR with area under the curve (AUC) of 0.82 (95% CI 0.75–0.89). In a multivariate model, AUC for combination of BNP and hydronephrosis was 0.86 (95% CI 0.79–0.93, P = 0.007).

Conclusions

Infants ≤ 2 months of age admitted for a first UTI are at risk for grade 3–5 VUR and thus should undergo a voiding cystourethrography (VCUG) if their renal ultrasound is abnormal or if they have Pseudomonas UTI. Avoiding VCUG can be considered in afebrile infants and in infants with BNP < 53% or NLR < 1.65.

Keywords

Urinary tract infection Young infants Vesicoureteral reflux Voiding cystourethrography 

Notes

Compliance with ethical standards

The study was approved by the institutional Research Ethics Board, waiving the need for informed consent.

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© IPNA 2019

Authors and Affiliations

  • Hilla Bahat
    • 1
    • 2
  • Mai Ben-Ari
    • 1
  • Tomer Ziv-Baran
    • 2
    • 3
  • Amos Neheman
    • 2
    • 4
  • Ilan Youngster
    • 1
    • 2
  • Michael Goldman
    • 1
    • 2
  1. 1.Department of PediatricsAssaf Harofeh Medical CenterZerifinIsrael
  2. 2.Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
  3. 3.Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  4. 4.Department of UrologyAssaf Harofeh Medical CenterZerifinIsrael

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