Cystourethrograms Not Required For All Infant Urinary Tract Infections

According to research published in the Journal of Maternal-Fetal & Neonatal Medicine, routine voiding cystourethrograms (VCUGs) are only required for infants after urinary tract infection (UTI) treatment in the neonatal intensive care unit (NICU) if severe or persistent abnormalities exist on renal ultrasound. Currently, there are no well-defined guidelines for UTI in neonates and premature neonates.

Data on infants born between 2000 and 2013, diagnosed with a UTI, and admitted to the NICU in 3 centers were used to investigate the utility of VCUG.  In total, 126 infants diagnosed with UTI during hospitalization were included in the study; most of the infants were premature and male. No patient had major prenatally diagnosed renal or urethral abnormalities, and 11.9% had mild pyelectasis demonstrated on prenatal ultrasound.

Renal ultrasound was performed in 115 (91.2%) infants; 69 (60%) of these showed abnormalities, of which the most common were mild to moderate hydronephrosis or pelviectasis (30%). Severe abnormalities were discovered in 14 (12%) infants. VCUG was performed in 71 (56%) infants, of which 3 (4%) were considered abnormal with grade 2 vesicoureteral reflux (VUR) or less (renal ultrasound was normal in 2 infants and abnormal in 1).

The investigators concluded that “routine VCUG after the first UTI in the NICU has a low yield and may potentially be reserved for infants with severe or persistent abnormalities on [renal ultrasound] or other risk factors such as recurrent or atypical UTIs.”  However, more “population-based studies” are needed, as the researchers state limitations in the study may have underestimated the prevalence of VUR, and they did not account for colony-forming units per mL of urine in the UTI diagnosis.

Reference

Flannery DD, Brandsma E, Saslow J, Mackley AB, Paul DA, Aghai ZH. Do infants in the neonatal intensive care unit diagnosed with urinary tract infection need a routine voiding cystourethrogram?  J Matern Fetal Neonatal Med. 2017:1-6.