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Long-term follow-up of premature infants with urinary tract infection

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Abstract

Urinary tract infection (UTI) is common in preterm infants and may have long-term sequela, such as recurrent infections and renal scarring in older children. We assessed long-term outcomes of preterm infants with UTI, born during 1996–2008 in Schneider Children’s Medical Center’s neonatal intensive care unit (NICU), and incidence of UTI recurrence. Of 89 preterm infants, seven were excluded due to prenatal diagnosis of congenital anomalies of the kidney and urinary tract (CAKUT), 41 interviewed by phone, 18 presented for follow-up evaluation in the nephrology clinic, and 23 lost to follow-up. No patient who completed follow-up reported additional UTI episodes or issues related to kidney and urinary tract. Clinically evaluated participants were 17.1 ± 3.6 years, born prematurely at 29.4 ± 4 weeks. All had a normal estimated glomerular filtration rate of >90 ml/min/1.73m2; four (22%) had systolic blood pressure >90th percentile; none had proteinuria (mean protein/creatinine ratio 0.09 ± 0.04 mg/mg) or albuminuria (mean albumin/creatinine ratio 10.2 ± 6.3 mcg/mg). Renal ultrasonography done in the first years of life in 12 (66%) patients demonstrated normal kidney size and structure.

Conclusion: In this pilot study, a single episode of UTI in premature infants without CAKUT did not constitute a risk factor for recurrence of infections or kidney injury in their first two decades of life. Thus, normal ultrasound in NICU excluding CAKUT may be sufficient for premature patients with UTI, with no need of further imaging or long-term nephrology follow-up.

What is Known:

• Urinary tract infection (UTI) is one of the most common bacterial infections in neonates and premature infants. Risk factors for UTI recurrence in children are congenital anomalies of the kidney and urinary tract (CAKUT) and bladder and bowel dysfunction.

• The recurrence rate and long-term renal sequela of UTI in preterm infants have not been studied. Guidelines regarding management and long-term follow-up for infants less than 2 months old are lacking.

What is New:

• A single episode of UTI in premature infants without CAKUT probably does not constitute a risk factor for UTI recurrence, and it is unlikely to cause renal injury in the first two decades of life.

• For premature infants with UTI without sonographic diagnosis of CAKUT in NICU, prophylactic antibiotic treatment, further imaging, or long-term nephrology follow-up may be unnecessary.

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Availability of data and material

All data and materials support published claims and comply with field standards.

Code availability

N/A.

Abbreviations

AAP:

American Academy of Pediatrics

ACR:

Albumin/creatinine ratio

CAKUT:

Congenital anomalies of the kidney and urinary tract

CFU:

Colony-forming units

eGFR:

Estimated glomerular filtration rate

ELBW:

Extremely low birth weight

LBW:

Low birth weight

NICE:

National Institute for Health and Care Excellence

NICU:

Neonatal Intensive Care Unit

PCR:

Protein/creatinine ratio

SCMC:

Schneider Children’s Medical Center

SCr:

Serum creatinine

SPA:

Supra-pubic aspiration

US:

Ultrasonography

UTI:

Urinary tract infection

VCUG:

Voiding cystourethrogram

VLBW:

Very low birth weight

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Author information

Authors and Affiliations

  1. Department of Pediatrics B, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel

    Lotem Goldberg

  2. Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel

    Lotem Goldberg, Yael Borovitz, Nir Sokolover & Miriam Davidovits

  3. Institute of Pediatric Nephrology, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel

    Yael Borovitz & Miriam Davidovits

  4. Neonatal Intensive Care Unit, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel

    Nir Sokolover

  5. Pediatric Nephrology Unit, Emek Medical Center, Afula, Israel

    Asaf Lebel

Authors
  1. Lotem Goldberg
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  2. Yael Borovitz
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  3. Nir Sokolover
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  4. Asaf Lebel
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  5. Miriam Davidovits
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Contributions

All authors have seen and approved the manuscript and contributed significantly to the work.

Corresponding author

Correspondence to Lotem Goldberg.

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Ethics approval

The study was approved by the Ethical Board Committee of Rabin and Schneider Children’s Medical Centers.

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Oral or written consent was given by the adult participant or by the parents of minor participants, as approved by the committee.

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N/A.

Conflict of interest

The authors declare no competing interests.

Additional information

Communicated by Gregorio Paolo Milani

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Goldberg, L., Borovitz, Y., Sokolover, N. et al. Long-term follow-up of premature infants with urinary tract infection. Eur J Pediatr 180, 3059–3066 (2021). https://doi.org/10.1007/s00431-021-04131-x

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  • DOI: https://doi.org/10.1007/s00431-021-04131-x

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