Three Part Question
In [children <2years] with [proven UTI ]what is the [incidence of significant underlying genito-urinary abnormality]?
A 12 month old baby presents to the Emergency department and you suspect UTI. The hospital policy is to refer to the infant to paediatrics. You wonder why this is the case and the paediatrician explains that it is because of the need to investigate this young age group due to the high incidence of GU abnormalities in children <2years. You wonder what the incidence oF GU abnormality is in children <2years
Medline, EMBASE and CINAHL via Ovid
Medline: [BestBETs paediatric filter] AND [urinary tract infection.mp./ or exp urinary tract infections/ OR exp bladder, neurogenic/OR urogenital abnormalities.mp./or exp urogenital abnormalities]
Limit humans and english language and abstracts and "reviews (optimized)"
EMBASE: same search as above but Limit to humans and abstracts and english language and infant or preschool child <1 to 6 years>
CINAHL: Same search as above but Limit to abstarcts and english
Medline 103 papers
EMBASE 476 papers
CINAHL 16 papers
One systematic literature review and 2 prevalence studies were relevant to this BET
|Author, date and country
||Study type (level of evidence)
|E Ring, G Zobel|
|140 patients aged between 4 days-12 months, admitted to the paediatric department with their first UTI, between January 1883 and December 1986||Prevalence Study||Incidence of urinary tract malformations||42% (no significant differences in age/sex amongf infants with/without malformations)||Small sample size|
|61% had malformations before 3months of age|
|incidence of VUR and Obstructive uropthay||VUR 25%, Obstructive uropathy 12%|
|Cleper R. Krause I. Eisenstein B. Davidovits M|
|Files of 64 patients admitted to the paediatric nephrology clinic withe the diagnosis of either neonatal sepsis work-up or neonatal UTI, between January 1997-May 1999||Prevalence Study||Incidence of VUR||20.3% (20% males, 22% females)||Not all urine sample obtained by the same method
Small sample size
Many more makles than females|
|Age at diagnosis of UTI||0-7 days 50%, 8-14 days 27% 15-21 days 13%, 22-28 days 0%|
|250 articles from the literature, from a personal collection, electronic literature search, and from references of primary articles, including newborns-18years of age, and publications up to early 1999||Systematic literature review||Incidence of VUR in children with UTI||31.1%||Limitations of the review were identified by the author himself:
Less than one third of the articles which were included in the review actually met the inclusion criteria, and there were quite a few papers that wer3 biased in their outcomes which were included.
Heterogeniety among age groups among the studies included.
Results from different imaging techniques used to diagnose malformations such as UTI with different sensitivities.
Heterogeniety of age, sex, grade/type of reflux, history of UTI|
|Incidence of VUR in normal children||9.0%|
|Incidence of VUR in children <1 year||31.0%|
|Incidence of VUR in male UTI||30.0%|
|Incidence of VUR in female UTI||33.1%|
|Jacobson SH. Hansson S. Jakobsson B|
|9 papers including children between 0-18 years of age with VUR and symptomatic UTI||Systematic literature review||Incidence of VUR in children with symptomatic UTI||32%||No methods section with details of search strategies, inclusion criterias etc
Heterogenity of age and sex of patients included in various studies
Small numbers of papers reviewed|
|Incidence of VUR in children with a prenatal diagnosis of urinary tract abnormality||24%|
There is no study that has investigated the incidence of genito-urinary abnormality in children <2years old with proven UTI. The review done by MA Sargent looked into the prevalence of of VUR in children with UTI or other abnormalities, and concluded that the incidence of VUR in children presenting with UTI was equal in children <1year, <5 years and >5years (30.3-31.0%). The other review looking at the incidence of VUR also concluded a similar prevalence of between 30-35%. The only paper identified whuich looked at malformations of the urinary tract in general (and did not just focus on VUR), found that malformations were present in 42% of infants, with 61% having a UTI before 3 months of age, however, this study was very small (140 infants in involved), therefore much more research is needed.
Clinical Bottom Line
No evidence has been found to answer the 3-part question in identifying the incidence of genito-urinary abnormalitiy in children <2 years with proven UTI.
- E Ring, G Zobel Urinary infection and malformations of urinary tract in infancy Archives of Disease in Childhood 63(7)(pp 818-820), 1988
- Cleper R. Krause I. Eisenstein B. Davidovits M Prevalence of vesicoureteral reflux in neonatal urinary tract infection Clinical Pediatrics 43(7)(pp 619-625), 2004
- Sargent MA What is the normal prevalence of vesicoureteral reflux? Pediatric Radiology 30(9):587-93, 2000 Sep
- Jacobson SH. Hansson S. Jakobsson B Vesico-ureteric reflux and other risk factors for renal damage: identification of high- and low-risk children Acta Paediatrica Supplement 88(431):31-9, 1999 Nov